Provider Demographics
NPI:1609511971
Name:BROWN, KING
Entity Type:Individual
Prefix:
First Name:KING
Middle Name:
Last Name:BROWN
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 1:6710 ROSEMEAD BLVD APT 12
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-1563
Mailing Address - Country:US
Mailing Address - Phone:626-627-6581
Mailing Address - Fax:
Practice Address - Street 1:6710 ROSEMEAD BLVD APT 12
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-1563
Practice Address - Country:US
Practice Address - Phone:626-627-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician