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NPI Code Detail

MEDICARE: SUSIE KIM

MEDICARE: SUSIE KIM
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1720589443
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSIE KIM
Provider Business Mailing Address
First Line : 2075 LA MIEL CT
Second Line :
City : CAMPBELL
State : CA
Zip : 95008-2608
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1835 PARK AVE
Second Line :
City : SAN JOSE
State : CA
Zip : 95126-1629
Country : US
Telephone Number : 303-989-8169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2018
Last Update Date : 10/10/2019

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Directions to “ SUSIE KIM ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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