Provider Demographics
NPI:1811970361
Name:KING, NICHOLAS A (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:504 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6917
Mailing Address - Country:US
Mailing Address - Phone:805-739-3474
Mailing Address - Fax:
Practice Address - Street 1:310 SOUTH HALCYON ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3863
Practice Address - Country:US
Practice Address - Phone:805-574-1690
Practice Address - Fax:805-574-1691
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG85437207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G854370OtherBLUE SHIELD PIN#
CAG85437OtherBLUE CROSS
CA7791583OtherAETNA PIN
CA486640100OtherDEPT OF LABOR
CA00G854370Medicaid
CA486640100OtherDEPT OF LABOR
CA7791583OtherAETNA PIN