MEDICARE: KAILYN MARIE OWENS

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	103K00000X	CA

General Provider Information

NPI Number	:	1356199301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILYN MARIE OWENS

Provider Business Mailing Address
First Line	:	7910 LA TIJERA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3134
Country	:	US
Telephone Number	:	424-522-2482
Fax Number	:

Provider Business Practice Location Address
First Line	:	7910 LA TIJERA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3134
Country	:	US
Telephone Number	:	657-242-2079
Fax Number	:

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

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	05/07/2024

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