Healthcare Provider Details

I. General information

NPI: 1477229938
Provider Name (Legal Business Name): DANAE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7049 AUSTIN ST
FOREST HILLS NY
11375-1033
US

IV. Provider business mailing address

4258 CHESTNUT ST APT 507
PHILADELPHIA PA
19104-3384
US

V. Phone/Fax

Practice location:
  • Phone: 718-280-1245
  • Fax:
Mailing address:
  • Phone: 516-312-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: