1861561243 NPI number — GENEVIEVE ASHCOM KING M. D.

Table of content: GENEVIEVE ASHCOM KING M. D. (NPI 1861561243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861561243 NPI number — GENEVIEVE ASHCOM KING M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
GENEVIEVE
Provider Middle Name:
ASHCOM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ASHCOM
Provider Other First Name:
GENEVIEVE
Provider Other Middle Name:
SUSANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861561243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21129 DAWE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASTRO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94546-5755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-586-0284
Provider Business Mailing Address Fax Number:
510-397-2075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3636 CASTRO VALLEY BLVD
Provider Second Line Business Practice Location Address:
# 10
Provider Business Practice Location Address City Name:
CASTRO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94546-4460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-586-0284
Provider Business Practice Location Address Fax Number:
510-397-2075
Provider Enumeration Date:
11/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A69755 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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