1205117231 NPI number — KING MEDICAL MANAGEMENT

Table of content: DR. JEFFREY LYNN LANDON D.C. (NPI 1548306830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205117231 NPI number — KING MEDICAL MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KING MEDICAL MANAGEMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205117231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6958
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90212-6958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-542-2153
Provider Business Mailing Address Fax Number:
714-464-4442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 N GOLDEN CIRCLE DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-3914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-542-2153
Provider Business Practice Location Address Fax Number:
714-464-4442
Provider Enumeration Date:
09/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MORELAND
Authorized Official First Name:
TANYA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
714-542-2153

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com