Provider Demographics
NPI:1467690537
Name:KING, DANIEL JOHN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:KING
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 WILSHIRE BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1995
Mailing Address - Country:US
Mailing Address - Phone:310-200-9114
Mailing Address - Fax:310-575-1890
Practice Address - Street 1:11601 WILSHIRE BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1995
Practice Address - Country:US
Practice Address - Phone:310-200-9114
Practice Address - Fax:310-575-1890
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22105103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic