Provider Demographics
NPI:1083965321
Name:KENNETH R KING MD PS
Entity Type:Organization
Organization Name:KENNETH R KING MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-646-2960
Mailing Address - Street 1:1621 114TH AVE SE
Mailing Address - Street 2:STE 210
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6956
Mailing Address - Country:US
Mailing Address - Phone:425-646-2960
Mailing Address - Fax:
Practice Address - Street 1:1621 114TH AVE SE
Practice Address - Street 2:STE 210
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6956
Practice Address - Country:US
Practice Address - Phone:425-646-2960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016091102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty