MEDICARE: AILEEN KING M.D.

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	207V00000X	Obstetrics & Gynecology Physician	M-9406	ID

General Provider Information

NPI Number	:	1689623043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILEEN KING M.D.

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:	208-706-3220
Fax Number	:	208-706-3221

Provider Business Practice Location Address
First Line	:	9850 W ST LUKES DR STE 280
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-7912
Country	:	US
Telephone Number	:	208-706-3220
Fax Number	:	208-706-3221

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	02/08/2024

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