Provider Demographics
NPI:1407045172
Name:KING, JOSEPH WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WALTER
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:PO BOX 47148
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-7148
Mailing Address - Country:US
Mailing Address - Phone:425-525-2206
Mailing Address - Fax:
Practice Address - Street 1:900 SW 16TH ST STE 200
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2631
Practice Address - Country:US
Practice Address - Phone:425-525-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035260207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F93122Medicare UPIN