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NPI Code Detail

MEDICARE: BRADLEY KING

MEDICARE: BRADLEY KING
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1396525598
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY KING
Provider Business Mailing Address
First Line : 16255 VENTURA BLVD STE 830
Second Line :
City : ENCINO
State : CA
Zip : 91436-2317
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2496 W 4700 S
Second Line :
City : TAYLORSVILLE
State : UT
Zip : 84129-1655
Country : US
Telephone Number : 801-935-4171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2023
Last Update Date : 10/04/2023

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Directions to “ BRADLEY KING ” Practice Location

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