Healthcare Provider Details

I. General information

NPI: 1184554602
Provider Name (Legal Business Name): KINFOLK MO ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 KINGSLAND AVE SUITE 100 PMB1022
UNIVERSITY CITY MO
63130
US

IV. Provider business mailing address

725 KINGSLAND AVE SUITE 100 PMB1022
UNIVERSITY CITY MO
63130
US

V. Phone/Fax

Practice location:
  • Phone: 980-249-4010
  • Fax: 980-249-4011
Mailing address:
  • Phone: 980-249-4010
  • Fax: 980-249-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ZISHE RUBIN
Title or Position: CEO
Credential:
Phone: 917-246-8382