Provider Demographics
NPI:1114663358
Name:KAJIWARA, JACOB JUNG HOON (MS, AMFT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:JUNG HOON
Last Name:KAJIWARA
Suffix:
Gender:M
Credentials:MS, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 OCEAN PARK BLVD STE 3075
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5232
Mailing Address - Country:US
Mailing Address - Phone:310-612-2998
Mailing Address - Fax:424-600-7150
Practice Address - Street 1:2716 OCEAN PARK BLVD STE 3075
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5232
Practice Address - Country:US
Practice Address - Phone:310-612-2998
Practice Address - Fax:424-600-7150
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist