Provider Demographics
NPI:1144696220
Name:KINGSKIDS PHYSICIANS, LLC
Entity type:Organization
Organization Name:KINGSKIDS PHYSICIANS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNDAY
Authorized Official - Middle Name:CHUKS
Authorized Official - Last Name:OKPARAOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-653-1229
Mailing Address - Street 1:13932 BALTIMORE AVE
Mailing Address - Street 2:11
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5000
Mailing Address - Country:US
Mailing Address - Phone:443-653-1229
Mailing Address - Fax:410-315-7868
Practice Address - Street 1:13932 BALTIMORE AVE
Practice Address - Street 2:11
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5000
Practice Address - Country:US
Practice Address - Phone:443-653-1229
Practice Address - Fax:410-315-7868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGSKIDS PHYSICIANS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00644202080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD335147500Medicaid