Provider Demographics
NPI:1225263056
Name:DAVID KING-STEPHENS,M.D., INC
Entity Type:Organization
Organization Name:DAVID KING-STEPHENS,M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KING-STEPHENS, MD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-600-7880
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:STE 115
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-600-7880
Mailing Address - Fax:415-600-7885
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:STE 115
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-600-7880
Practice Address - Fax:415-600-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA670092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00408771OtherMEDICARE RAILROAD
CA00A670090Medicaid
CAG44444Medicare UPIN
CA00A670090Medicaid