Provider Demographics
NPI:1063790459
Name:MARTIN LUTHER KING, JR TECHNOLOGY ACADEMY
Entity type:Organization
Organization Name:MARTIN LUTHER KING, JR TECHNOLOGY ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:TEACHER
Authorized Official - Phone:916-566-3490
Mailing Address - Street 1:3051 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-1132
Mailing Address - Country:US
Mailing Address - Phone:916-566-3490
Mailing Address - Fax:
Practice Address - Street 1:3051 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-1132
Practice Address - Country:US
Practice Address - Phone:916-566-3490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty