Individual
JACQUELINE SHAY KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
300 MEDICAL PLAZA, #200, LOS ANGELES, CA 90095-0001
(310) 794-1801
Mailing address
5767 W CENTURY BLVD, SUITE 200, LOS ANGELES, CA 90045-5632
(310) 825-5111
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
RN666365
CA
363L00000X
Nurse Practitioner
RN666365
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RN666365
—
CA
Enumeration date
07/12/2006
Last updated
05/13/2011
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