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General NPI Number Information
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NPI Number | 1881559300
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Entity Type | Individual
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Provider Name | KENNITH DRA KIRK
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Gender | Male
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 560 E HOSPITALITY LANE
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City | SAN BERNARDINO
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State | CA
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Zip | 92408
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Country | US
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Telephone | 909-891-1599
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Fax | 877-306-6790
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Provider Business Mailing Address
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Address Line | 27050 STRATFORD ST
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City | HIGHLAND
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State | CA
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Zip | 92346
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Country | US
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Telephone | 714-329-3366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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