Provider Demographics
NPI:1417052341
Name:KING, MELISSA KUO (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KUO
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N TUSTIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3606
Mailing Address - Country:US
Mailing Address - Phone:714-664-0045
Mailing Address - Fax:714-664-0049
Practice Address - Street 1:720 N TUSTIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3606
Practice Address - Country:US
Practice Address - Phone:714-664-0045
Practice Address - Fax:714-664-0049
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95240207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPO1051340OtherMEDICARE RAILROAD TPAN:
CAPO1051340OtherMEDICARE RAILROAD TPAN: