Healthcare Provider Details

I. General information

NPI: 1306571914
Provider Name (Legal Business Name): APPLIED BEHAVIOR ANALYSIS LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 E SEASIDE WALK
LONG BEACH CA
90803
US

IV. Provider business mailing address

4712 E 2ND ST # 260
LONG BEACH CA
90803-5309
US

V. Phone/Fax

Practice location:
  • Phone: 562-681-0334
  • Fax: 757-551-9641
Mailing address:
  • Phone: 562-681-0334
  • Fax: 757-551-9641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JI SOO CHUNG
Title or Position: CO-OWNER
Credential: BCBA
Phone: 213-447-6057