Provider Demographics
NPI:1447633524
Name:KING, DAVID
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5588 N PALM AVE
Mailing Address - Street 2:SUITE P-4
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1913
Mailing Address - Country:US
Mailing Address - Phone:559-349-9588
Mailing Address - Fax:559-650-5590
Practice Address - Street 1:5588 N PALM AVE
Practice Address - Street 2:SUITE P-4
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1913
Practice Address - Country:US
Practice Address - Phone:559-349-9588
Practice Address - Fax:559-650-5590
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417820343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)