Provider Demographics
NPI:1174676282
Name:KING, KRISTIN (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 OSLER DR
Mailing Address - Street 2:RM 215
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7735
Mailing Address - Country:US
Mailing Address - Phone:410-825-6667
Mailing Address - Fax:410-828-1638
Practice Address - Street 1:7600 OSLER DR
Practice Address - Street 2:RM 215
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7735
Practice Address - Country:US
Practice Address - Phone:410-825-6667
Practice Address - Fax:410-828-1638
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1243171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist