Healthcare Provider Details

I. General information

NPI: 1982159349
Provider Name (Legal Business Name): JI YUN NAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JIYUN NAM

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10061 TALBERT AVE STE 200
FOUNTAIN VALLEY CA
92708-5123
US

IV. Provider business mailing address

21143 HAWTHORNE BLVD # 241
TORRANCE CA
90503-4615
US

V. Phone/Fax

Practice location:
  • Phone: 310-845-6151
  • Fax:
Mailing address:
  • Phone: 310-845-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: