Provider Demographics
NPI:1376294538
Name:KING, ANGEL KRISTINA
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:KRISTINA
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 W 94TH LN
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1746
Mailing Address - Country:US
Mailing Address - Phone:219-308-2123
Mailing Address - Fax:
Practice Address - Street 1:1537 W 94TH LN
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1746
Practice Address - Country:US
Practice Address - Phone:219-308-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program