Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003487620 |
---|---|
Provider Name | Vicky Chan |
First Address | Ventura, CA 93003-7783 |
Second Address | Culver City, CA 90230-6367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2021 |
Last Update Date | 06/07/2021 |