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NPI Code Detail

MEDICARE: CHRISTINA KIM

MEDICARE: CHRISTINA KIM
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
2171M00000XCase Manager/Care Coordinator
3103K00000XBehavior AnalystBACB410424CA

General Provider Information

NPI Number : 1538671656
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA KIM
Provider Business Mailing Address
First Line : 2141 PALOMAR AIRPORT RD STE 350
Second Line :
City : CARLSBAD
State : CA
Zip : 92011-1451
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 21600 OXNARD ST STE 1030
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-5085
Country : US
Telephone Number : 877-206-1009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2017
Last Update Date : 12/21/2021

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