Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G069056 | CA |
Y | 111NI0900X | Internist | G069056 | CA |
N | 207R00000X | Internist | G56069 | CA |
N | 111NI0900X | Internist | G56069 | CA |
NPI | 1003086828 |
---|---|
Provider Name | Dr. Jan B King |
First Address | Los Angeles, CA 90059-3015 |
Second Address | Los Angeles, CA 90059-3015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2008 |
Last Update Date | 18/04/2019 |