Provider Demographics
NPI:1407474786
Name:KING, ROBERT DAVID (HIS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:KING
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 NW 169TH PL STE 204
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7310
Mailing Address - Country:US
Mailing Address - Phone:971-219-9864
Mailing Address - Fax:
Practice Address - Street 1:1865 NW 169TH PL STE 204
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7310
Practice Address - Country:US
Practice Address - Phone:971-219-9864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-429696237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty