Healthcare Provider Details

I. General information

NPI: 1952426512
Provider Name (Legal Business Name): ELIZABETH SUN MEE-KIM RYU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE
LOS ANGELES CA
90020
US

IV. Provider business mailing address

605 W OLYMPIC BLVD STE 550
LOS ANGELES CA
90015-1474
US

V. Phone/Fax

Practice location:
  • Phone: 213-842-7003
  • Fax:
Mailing address:
  • Phone: 213-553-1850
  • Fax: 213-553-1864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS29658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: