Provider Demographics
NPI:1184891889
Name:KING PROSTHETICS & ORTHOTICS, INC.
Entity type:Organization
Organization Name:KING PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KING
Authorized Official - Suffix:SR
Authorized Official - Credentials:CP
Authorized Official - Phone:714-971-7221
Mailing Address - Street 1:12849 CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4100
Mailing Address - Country:US
Mailing Address - Phone:714-971-7221
Mailing Address - Fax:714-971-8784
Practice Address - Street 1:12849 CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4100
Practice Address - Country:US
Practice Address - Phone:714-971-7221
Practice Address - Fax:714-971-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASREA24775023335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ83067ZOtherBLUE SHIELDS OF CALIFORNIA
CA199429400OtherDEPARTMENT OF LABOR
CAGXC000390Medicaid
CA0222760001Medicare NSC