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NPI Code Detail

MEDICARE: JESSICA KIM MS

MEDICARE: JESSICA KIM MS
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
1390200000XStudent in an Organized Health Care Education/Training Program
2103K00000XBehavior Analyst1-18-33349CA

General Provider Information

NPI Number : 1841671088
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA KIM MS
Provider Business Mailing Address
First Line : 13501 SANDHURST PL
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-2741
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3303 HARBOR BLVD STE B10
Second Line :
City : COSTA MESA
State : CA
Zip : 92626-1537
Country : US
Telephone Number : 714-786-6069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2015
Last Update Date : 01/15/2026

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