Soonthorn Boonnoppornkul, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-23-65924 Issued in CA

Practice address

611 N Brand Blvd Ste 100
Glendale, CA 91203-3240

Phone

(747) 286-2600

Fax

(747) 204-0181

NPI assigned

May 8, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Joe Boonnoppornkul Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Autism Spectrum Therapies LLC

  • Community/Behavioral Health Agency
  • Pleasanton, CA
  • NPI 1215393178
  NPD (past)
• Autism Spectrum Therapies, LLC

  • Behavior Analyst
  • Burbank, CA
  • NPI 1609194000
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1639791098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6160 CORNERSTONE CT E STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213724",
            "telephone_number": "851-216-8837",
            "fax_number": "619-941-0276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 N BRAND BLVD STE 100",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912033240",
            "telephone_number": "747-286-2600",
            "fax_number": "747-204-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOONNOPPORNKUL",
        "first_name": "SOONTHORN",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-08",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-23-65924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOE",
            "last_name": "BOONNOPPORNKUL",
            "credential": "BCBA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Torieryn Boles-Armstrong
• Kirstie Bondoc
• Jennifer Bonilla
• Stephanie Bonilla
• Teodulo Cruz Bonzon, LCSW
• Jennifer Rose Boozer, DO
• Brock Allen Borah, DC
• Charlotte Carolyn Michelle Bories
• Joseph Bornheimer Jr., M.D.
• Joanna Bosque, LMFT

• Behavior Analyst in Glendale, CA
• Providers in Glendale, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.