Basic Information
| Provider Information | |||||||||
| NPI: | 1861608770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 44037 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850644037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029546228 | ||||||||
| FaxNumber: | 6029576142 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 W THOMAS RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029439200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | A129519 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | M7335 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 390200000X | M7335 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085N0700X | 60164 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
No ID Information.