Provider Demographics
NPI:1932192234
Name:KING, PHILIP W (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:W
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1370 116TH AVE NE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3825
Mailing Address - Country:US
Mailing Address - Phone:425-453-8406
Mailing Address - Fax:425-453-4173
Practice Address - Street 1:1370 116TH AVE NE
Practice Address - Street 2:SUITE 209
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3825
Practice Address - Country:US
Practice Address - Phone:425-453-8406
Practice Address - Fax:425-453-4173
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00039235207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1116425Medicaid
WA110238679OtherRR MEDICARE
WA1116425Medicaid
WA110238679OtherRR MEDICARE