Provider Demographics
NPI:1861484396
Name:KING, AUGUST DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:AUGUST
Middle Name:DANIEL
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 1:605 S. COOLIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1863
Mailing Address - Country:US
Mailing Address - Phone:509-765-0674
Mailing Address - Fax:509-765-6591
Practice Address - Street 1:605 S COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1893
Practice Address - Country:US
Practice Address - Phone:509-765-0674
Practice Address - Fax:509-765-6591
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60142503207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2007273Medicaid
WA0263877OtherL & I
WAG8892411Medicare PIN
WA2007273Medicaid
WA0263877OtherL & I