MEDICARE: NILOM KUNDU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1710637087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NILOM KUNDU

Provider Business Mailing Address
First Line	:	6550 YUCCA ST APT 312
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-4226
Country	:	US
Telephone Number	:	714-612-5530
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 YUCCA ST APT 312
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-4226
Country	:	US
Telephone Number	:	714-612-5530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	03/28/2022

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Directions to “ NILOM KUNDU ” Practice Location

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