Provider Demographics
NPI:1538869862
Name:KING, SYDNEY C (PA-C)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:C
Last Name:KING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25405 HANCOCK AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5983
Mailing Address - Country:US
Mailing Address - Phone:951-304-7854
Mailing Address - Fax:
Practice Address - Street 1:25405 HANCOCK AVE STE 108
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5983
Practice Address - Country:US
Practice Address - Phone:951-304-7854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62436363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant