MEDICARE: MARLYN KIM BCBA

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	95000467A	IN

General Provider Information

NPI Number	:	1144797077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLYN KIM BCBA

Provider Business Mailing Address
First Line	:	4950 SAN BERNARDINO ST STE 101
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 SAN BERNARDINO ST STE 101
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2328
Country	:	US
Telephone Number	:	808-800-7491
Fax Number	:

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

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	01/07/2026

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