Provider Demographics
NPI:1457866683
Name:OH, JIYE AMY (BCBA)
Entity Type:Individual
Prefix:
First Name:JIYE
Middle Name:AMY
Last Name:OH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JIYE
Other - Middle Name:AMY
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4750 CONRAD AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2023
Mailing Address - Country:US
Mailing Address - Phone:909-993-2028
Mailing Address - Fax:
Practice Address - Street 1:3685 KEARNY VILLA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1950
Practice Address - Country:US
Practice Address - Phone:858-966-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
CA1-20-41323103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool