Healthcare Provider Details

I. General information

NPI: 1326417361
Provider Name (Legal Business Name): KIM ZHU M.S., BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 1/2 COLORADO BLVD
LOS ANGELES CA
90041-1338
US

IV. Provider business mailing address

1722 1/2 COLORADO BLVD
LOS ANGELES CA
90041-1338
US

V. Phone/Fax

Practice location:
  • Phone: 323-744-1314
  • Fax:
Mailing address:
  • Phone: 323-744-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-15355
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-15355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: