Provider Demographics
NPI:1144067471
Name:KING, JOHN MITCHELL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MITCHELL
Last Name:KING
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1974
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-1974
Mailing Address - Country:US
Mailing Address - Phone:858-248-9784
Mailing Address - Fax:
Practice Address - Street 1:8929 UNIVERSITY CENTER LN STE 205
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1008
Practice Address - Country:US
Practice Address - Phone:858-703-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65926207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery