MEDICARE: DR. KIRK E KING DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE8201	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE8201	OTHER	WA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1497758148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRK E KING DDS

Provider Business Mailing Address
First Line	:	66 WILLIAMS AVE S
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057
Country	:	US
Telephone Number	:	425-226-4090
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 WILLIAMS AVE S
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057
Country	:	US
Telephone Number	:	425-226-4090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/28/2007

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