Provider Demographics
NPI:1629262258
Name:KING, JUSTIN BENARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BENARD
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:610 EUCLID AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2951
Mailing Address - Country:US
Mailing Address - Phone:619-472-2665
Mailing Address - Fax:619-479-9468
Practice Address - Street 1:610 EUCLID AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2951
Practice Address - Country:US
Practice Address - Phone:619-472-2665
Practice Address - Fax:619-479-9468
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA89447208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery