MEDICARE: BRIAN F. 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	2085R0202X	Diagnostic Radiology Physician	G66685	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300128255	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00G666850	OTHER		BLUE SHIELD OF CA

General Provider Information

NPI Number	:	1871515650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN F. KING M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5667
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92863-5667
Country	:	US
Telephone Number	:	714-571-5000
Fax Number	:	714-571-5055

Provider Business Practice Location Address
First Line	:	11620 WILSHIRE BLVD
Second Line	:	STE. 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1706
Country	:	US
Telephone Number	:	310-914-7336
Fax Number	:	310-914-7326

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	08/15/2008

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Directions to “ BRIAN F. KING M.D.” Practice Location

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