Provider Demographics
NPI:1275502064
Name:KING, JOSEPH TAK-PUN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TAK-PUN
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019481E207ZP0102X
NY148619-1207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00793999Medicaid
PA220029212OtherRR MEDICARE PIN
PAGU039827OtherMEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PA0006853790001Medicaid
NYCC2053Medicare ID - Type Unspecified
PACC9269OtherRR MEDICARE GROUP
PAGU039827OtherMEDICARE GROUP