Provider Demographics
NPI:1033180484
Name:KING, EDWIN KIM (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:KIM
Last Name:KING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3212 SW 89TH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7907
Mailing Address - Country:US
Mailing Address - Phone:405-378-3300
Mailing Address - Fax:405-378-9933
Practice Address - Street 1:3212 SW 89TH
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7907
Practice Address - Country:US
Practice Address - Phone:405-378-3300
Practice Address - Fax:405-378-3993
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2015-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK2534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100200420AMedicaid
OKP00265485OtherRAILROAD MEDICARE
OKE09797Medicare UPIN
OK245519201Medicare PIN