Provider Demographics
NPI:1982743613
Name:BYRON KING, MD, INC.
Entity Type:Organization
Organization Name:BYRON KING, MD, INC.
Other - Org Name:BYRON KING, MD, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:F
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-560-0422
Mailing Address - Street 1:3939 RUFFIN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1815
Mailing Address - Country:US
Mailing Address - Phone:858-560-0422
Mailing Address - Fax:858-633-0392
Practice Address - Street 1:3939 RUFFIN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1815
Practice Address - Country:US
Practice Address - Phone:858-560-0422
Practice Address - Fax:858-633-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26948204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43156Medicare UPIN