Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003306077 |
---|---|
Provider Name | So Jung Kim |
First Address | San Francisco, CA 94121-2752 |
Second Address | San Francisco, CA 94121-2752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2018 |
Last Update Date | 15/05/2018 |