Provider Demographics
NPI:1669701686
Name:HUYNEN, KIM BEA (PHD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:BEA
Last Name:HUYNEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 MYRA AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4569
Mailing Address - Country:US
Mailing Address - Phone:714-828-6400
Mailing Address - Fax:714-828-3400
Practice Address - Street 1:5340 MYRA AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4569
Practice Address - Country:US
Practice Address - Phone:714-828-6400
Practice Address - Fax:714-828-3400
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA 1-00-0238103K00000X
CAPSY 15010103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst