Healthcare Provider Details

I. General information

NPI: 1740656479
Provider Name (Legal Business Name): JUNG YEON YIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 UNIVERSITY DR # 10014
IRVINE CA
92612-2965
US

IV. Provider business mailing address

5319 UNIVERSITY DR # 10014
IRVINE CA
92612-2965
US

V. Phone/Fax

Practice location:
  • Phone: 949-345-0945
  • Fax:
Mailing address:
  • Phone: 949-345-0945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: