Provider Demographics
NPI:1518076611
Name:KING, JENNIFER A (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
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 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:STE 347
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5650
Mailing Address - Country:US
Mailing Address - Phone:480-429-4690
Mailing Address - Fax:480-429-9553
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:STE 347
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5650
Practice Address - Country:US
Practice Address - Phone:480-429-4690
Practice Address - Fax:480-429-9553
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0755250OtherBLXBLS OF AZ
AZ865595001Medicaid
AZZ82046Medicare PIN
AZ865595001Medicaid