MEDICARE: KEVIN MICHAEL SILAS KING PA-C

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	363A00000X	Physician Assistant	PA21149	CA

General Provider Information

NPI Number	:	1841509171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN MICHAEL SILAS KING PA-C

Provider Business Mailing Address
First Line	:	708 NAVITO WAY
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93030
Country	:	US
Telephone Number	:	310-367-2819
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 N CALIFORNIA BLVD
Second Line	:	SUITE 400
City	:	WALNUT CREEK
State	:	CA
Zip	:	94596-3742
Country	:	US
Telephone Number	:	925-225-5837
Fax Number	:

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

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	07/31/2015

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