Provider Demographics
NPI:1548371925
Name:KING, BYRON (MD, INC,)
Entity type:Individual
Prefix:DR
First Name:BYRON
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:MD, INC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 RUFFIN RD STE 101
Mailing Address - Street 2:
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 STE 101
Practice Address - Street 2:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26948207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43156Medicare UPIN