Provider Demographics
NPI:1346993078
Name:ELAINE Y. KING M.D.,INC.
Entity Type:Organization
Organization Name:ELAINE Y. KING M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-873-0399
Mailing Address - Street 1:4425 JAMBOREE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3044
Mailing Address - Country:US
Mailing Address - Phone:949-873-0399
Mailing Address - Fax:949-539-8166
Practice Address - Street 1:4425 JAMBOREE RD STE 120
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3044
Practice Address - Country:US
Practice Address - Phone:949-873-0399
Practice Address - Fax:949-539-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty