MEDICARE: SONNI KIM BCABA

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	1-20-41718	NJ

General Provider Information

NPI Number	:	1861954406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONNI KIM BCABA

Provider Business Mailing Address
First Line	:	125 HALF MILE RD STE 200
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-6749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ENTERPRISE DRIVE
Second Line	:	SUITE 301
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-2129
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

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

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	05/14/2026

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Directions to “ SONNI KIM BCABA” Practice Location

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