Provider Demographics
NPI:1861561243
Name:KING, GENEVIEVE ASHCOM (M D)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:ASHCOM
Last Name:KING
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:SUSANNE
Other - Last Name:ASHCOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:21129 DAWE AVE
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5755
Mailing Address - Country:US
Mailing Address - Phone:510-586-0284
Mailing Address - Fax:510-397-2075
Practice Address - Street 1:3636 CASTRO VALLEY BLVD
Practice Address - Street 2:# 10
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4460
Practice Address - Country:US
Practice Address - Phone:510-586-0284
Practice Address - Fax:510-397-2075
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH02991Medicare UPIN
CA00A697550Medicare ID - Type Unspecified