Basic Information
| Provider Information | |||||||||
| NPI: | 1104270313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | KRISTINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 931 S MARKET BLVD | ||||||||
| Address2: | |||||||||
| City: | CHEHALIS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985323423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607676305 | ||||||||
| FaxNumber: | 3607676320 | ||||||||
| Practice Location | |||||||||
| Address1: | 931 S MARKET BLVD | ||||||||
| Address2: | |||||||||
| City: | CHEHALIS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985323423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607676300 | ||||||||
| FaxNumber: | 3607676320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2016 | ||||||||
| LastUpdateDate: | 05/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60869831 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ML60659137 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.