MEDICARE: APPLIED BEHAVIOR ANALYSIS LOS ANGELES

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

General Provider Information

NPI Number	:	1306571914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLIED BEHAVIOR ANALYSIS LOS ANGELES

Provider Business Mailing Address
First Line	:	4712 E 2ND ST # 260
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5309
Country	:	US
Telephone Number	:	562-681-0334
Fax Number	:	757-551-9641

Provider Business Practice Location Address
First Line	:	6605 E SEASIDE WALK
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803
Country	:	US
Telephone Number	:	562-681-0334
Fax Number	:	757-551-9641

Authorized Official
Title or Position	:	CO-OWNER
Name	:	JI SOO CHUNG
Credential	:	BCBA
Telephone Number	:	213-447-6057

Provider Enumeration Date	:	07/18/2022
Last Update Date	:	02/11/2026

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