Provider Demographics
NPI:1700113727
Name:KING CITY JOINT UNION HIGH SCHOOL DISTRICT
Entity Type:Organization
Organization Name:KING CITY JOINT UNION HIGH SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:831-385-0606
Mailing Address - Street 1:800 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-3326
Mailing Address - Country:US
Mailing Address - Phone:831-385-0606
Mailing Address - Fax:831-385-0695
Practice Address - Street 1:800 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3326
Practice Address - Country:US
Practice Address - Phone:831-385-0606
Practice Address - Fax:831-385-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2766068OtherMEDI-CAL PROVIDER NUMBER