Provider Demographics
NPI:1083015556
Name:LAW, CHUNG YIN (MED, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:CHUNG YIN
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 CASA VERDE ST
Mailing Address - Street 2:APT 2310
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-3322
Mailing Address - Country:US
Mailing Address - Phone:408-917-8237
Mailing Address - Fax:
Practice Address - Street 1:7172 REGIONAL ST # 111
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2324
Practice Address - Country:US
Practice Address - Phone:510-999-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11313454103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst