Provider Demographics
NPI:1407560238
Name:KING, EDWARD AR
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:AR
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6226 TEVIS ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-3965
Mailing Address - Country:US
Mailing Address - Phone:209-535-8189
Mailing Address - Fax:
Practice Address - Street 1:2283 MAIN STREET
Practice Address - Street 2:ATTN: BEHAVIORAL HEALTH WORKS
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-9454
Practice Address - Country:US
Practice Address - Phone:800-249-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician