Provider Demographics
NPI:1477145662
Name:BANKS, DANIEL LEE
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEE
Last Name:BANKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7133 HAWTHORN AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3277
Mailing Address - Country:US
Mailing Address - Phone:310-922-2469
Mailing Address - Fax:
Practice Address - Street 1:1106 N LA CIENEGA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2493
Practice Address - Country:US
Practice Address - Phone:310-922-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19019171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist