Provider Demographics
NPI:1740235845
Name:KING, CHARLES S (PA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:KING
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:1160 E 3900 S
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1202
Mailing Address - Country:US
Mailing Address - Phone:801-266-3418
Mailing Address - Fax:801-288-4444
Practice Address - Street 1:1160 E 3900 S
Practice Address - Street 2:SUITE 2000
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1202
Practice Address - Country:US
Practice Address - Phone:801-266-3418
Practice Address - Fax:801-288-4444
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT100994-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical