Provider Demographics
NPI:1689873671
Name:KING, KAHINA ETOSSI (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:KAHINA
Middle Name:ETOSSI
Last Name:KING
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:KAHINA
Other - Middle Name:ETOSSI
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 438394
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-8394
Mailing Address - Country:US
Mailing Address - Phone:773-609-2545
Mailing Address - Fax:
Practice Address - Street 1:1015 DONALD LEE HOLLOWELL PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-6653
Practice Address - Country:US
Practice Address - Phone:678-553-4924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122505122300000X, 1223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice