Provider Demographics
NPI:1508339359
Name:KIM, JACQUELYN MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:MARIE
Last Name:KIM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WINCHESTER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1163
Mailing Address - Country:US
Mailing Address - Phone:888-769-7827
Mailing Address - Fax:408-625-1119
Practice Address - Street 1:1700 WINCHESTER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1163
Practice Address - Country:US
Practice Address - Phone:888-769-7827
Practice Address - Fax:408-625-1119
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst