Provider Demographics
NPI:1508300112
Name:KIM, JUNG SUN SUNNY (PHD, BCBA)
Entity Type:Individual
Prefix:
First Name:JUNG SUN
Middle Name:SUNNY
Last Name:KIM
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:SUNNY
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, BCBA
Mailing Address - Street 1:5402 COKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1626
Mailing Address - Country:US
Mailing Address - Phone:415-328-2226
Mailing Address - Fax:
Practice Address - Street 1:5402 COKE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1626
Practice Address - Country:US
Practice Address - Phone:415-328-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-9524103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst