Provider Demographics
NPI:1588056428
Name:IZAI, SHUNSUKE (BCBA)
Entity type:Individual
Prefix:
First Name:SHUNSUKE
Middle Name:
Last Name:IZAI
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4221 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3512
Mailing Address - Country:US
Mailing Address - Phone:323-866-1880
Mailing Address - Fax:323-866-1881
Practice Address - Street 1:1906 W GARVEY AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2652
Practice Address - Country:US
Practice Address - Phone:323-866-1880
Practice Address - Fax:323-866-1881
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-9956103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst