Provider Demographics
NPI:1316125081
Name:AUBREY KING ,MD INC
Entity type:Organization
Organization Name:AUBREY KING ,MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/ MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:ANCIL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-946-0707
Mailing Address - Street 1:545 N MOUNTAIN AVE
Mailing Address - Street 2:201
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5073
Mailing Address - Country:US
Mailing Address - Phone:909-946-0707
Mailing Address - Fax:909-946-1946
Practice Address - Street 1:545 N MOUNTAIN AVE
Practice Address - Street 2:201
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5073
Practice Address - Country:US
Practice Address - Phone:909-946-0707
Practice Address - Fax:909-946-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56023323P00000X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF01159Medicare UPIN