Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 1-16-24737 | CA |
NPI | 1093251605 |
---|---|
Provider Name | Amanda Kim |
First Address | Woodland Hills, CA 91367-4976 |
Second Address | Woodland Hills, CA 91367-2543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2017 |
Last Update Date | 06/01/2017 |