Individual
DIANA KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BACHELORS
Contact information
Practice address
1115 14TH ST, MODESTO, CA 95354-1003
(209) 572-2589
Mailing address
1113 WHITTLE CT, MODESTO, CA 95351-3461
(209) 678-4385
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
18-51927
CA
106E00000X
Assistant Behavior Analyst
Primary
RBT-18-51927
CA
Other
Enumeration date
03/29/2018
Last updated
03/29/2018
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