Provider Demographics
NPI:1154916351
Name:KING HEALTH SYSTEMS LLC
Entity type:Organization
Organization Name:KING HEALTH SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SULE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-804-7652
Mailing Address - Street 1:7826 EASTERN AVE NW STE LL18
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1328
Mailing Address - Country:US
Mailing Address - Phone:202-545-0021
Mailing Address - Fax:
Practice Address - Street 1:7826 EASTERN AVE NW STE LL18
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1328
Practice Address - Country:US
Practice Address - Phone:202-545-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000OtherNA