Provider Demographics
NPI:1487050860
Name:KING, CORNELIUS
Entity type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 RICHMOND AVE
Mailing Address - Street 2:577
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5929
Mailing Address - Country:US
Mailing Address - Phone:281-501-0622
Mailing Address - Fax:
Practice Address - Street 1:6420 RICHMOND AVE
Practice Address - Street 2:577
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5929
Practice Address - Country:US
Practice Address - Phone:281-501-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171WV0202XOther Service ProvidersContractorVehicle Modifications