Provider Demographics
NPI:1154073823
Name:KING OF KINGS LLL
Entity Type:Organization
Organization Name:KING OF KINGS LLL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COF
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KAHNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-804-5875
Mailing Address - Street 1:1910 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4455
Mailing Address - Country:US
Mailing Address - Phone:619-804-5875
Mailing Address - Fax:
Practice Address - Street 1:1909 S FREEMAN ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6430
Practice Address - Country:US
Practice Address - Phone:442-266-2107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty