Basic Information
| Provider Information | |||||||||
| NPI: | 1306228010 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | JOHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25455 BARTON RD STE 102B | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923543139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095582808 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 25455 BARTON RD STE 102B | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923543139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095582808 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2015 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | R3811 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207XS0106X | 178411 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.