Provider Demographics
NPI:1952329625
Name:KING, ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 JAMBOREE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3044
Mailing Address - Country:US
Mailing Address - Phone:949-873-0399
Mailing Address - Fax:949-539-8166
Practice Address - Street 1:4425 JAMBOREE RD STE 120
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3044
Practice Address - Country:US
Practice Address - Phone:949-873-0399
Practice Address - Fax:949-539-8166
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine