Provider Demographics
NPI:1831993401
Name:KING, DYNASTY
Entity type:Individual
Prefix:
First Name:DYNASTY
Middle Name:
Last Name:KING
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 E IDO AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-2010
Mailing Address - Country:US
Mailing Address - Phone:330-212-7439
Mailing Address - Fax:
Practice Address - Street 1:83 E IDO AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-2010
Practice Address - Country:US
Practice Address - Phone:330-212-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care