Provider Demographics
NPI:1558108779
Name:KING, JALEN ALSHAH
Entity type:Individual
Prefix:
First Name:JALEN
Middle Name:ALSHAH
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 1:5963 MAPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1646
Mailing Address - Country:US
Mailing Address - Phone:216-450-2299
Mailing Address - Fax:
Practice Address - Street 1:5963 MAPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-1646
Practice Address - Country:US
Practice Address - Phone:216-450-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker