Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 103TS0200X | School Psychologist |
NPI | 1093133217 |
---|---|
Provider Name | Jane Kim |
First Address | Tujunga, CA 91042-1441 |
Second Address | Tujunga, CA 91042-1441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2014 |
Last Update Date | 04/04/2014 |