Healthcare Provider Details

I. General information

NPI: 1467690537
Provider Name (Legal Business Name): DANIEL JOHN KING PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 WILSHIRE BLVD STE 5
LOS ANGELES CA
90025-1995
US

IV. Provider business mailing address

11601 WILSHIRE BLVD STE 5
LOS ANGELES CA
90025-1995
US

V. Phone/Fax

Practice location:
  • Phone: 310-200-9114
  • Fax: 310-575-1890
Mailing address:
  • Phone: 310-200-9114
  • Fax: 310-575-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY 22105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: