Provider Demographics
NPI:1841226073
Name:KING, DANIEL MCKENZIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MCKENZIE
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CEDAR STREET
Mailing Address - Street 2:PO BOX 874
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080
Mailing Address - Country:US
Mailing Address - Phone:530-527-6123
Mailing Address - Fax:530-527-9514
Practice Address - Street 1:411 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080
Practice Address - Country:US
Practice Address - Phone:530-527-6123
Practice Address - Fax:530-527-9514
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39123207W00000X
TNMD0000014165207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5383418Medicaid
CA00G391230Medicare ID - Type Unspecified
A47711Medicare UPIN