Provider Demographics
NPI:1124498373
Name:KIM, JANE JOO YOUNG (MS, BCBA)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:JOO YOUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 EMBARCADERO
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5231
Mailing Address - Country:US
Mailing Address - Phone:510-832-4383
Mailing Address - Fax:510-550-1981
Practice Address - Street 1:1900 EMBARCADERO
Practice Address - Street 2:SUITE 310
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5231
Practice Address - Country:US
Practice Address - Phone:510-832-4383
Practice Address - Fax:510-550-1981
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA # 1-07-3571103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst