Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G53371 | CA |
NPI | 1154485753 |
---|---|
Provider Name | Warren King |
First Address | Los Altos, CA 94022-1408 |
Second Address | Palo Alto, CA 94301-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 03/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E13979 | (02) | CA |