Provider Demographics
NPI:1003086828
Name:KING, JAN B (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:B
Last Name:KING
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11833 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3015
Mailing Address - Country:US
Mailing Address - Phone:323-568-8701
Mailing Address - Fax:
Practice Address - Street 1:11833 WILMINGTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3015
Practice Address - Country:US
Practice Address - Phone:323-568-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56069207R00000X
CAG069056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine