Healthcare Provider Details

I. General information

NPI: 1942542899
Provider Name (Legal Business Name): EUN JIN RYU-LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: UN JIN RYU KIM

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 09/11/2021
Certification Date: 09/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 EUREKA AVE STE B3
YORBA LINDA CA
92886-3368
US

IV. Provider business mailing address

4811 EUREKA AVE STE B3
YORBA LINDA CA
92886-3368
US

V. Phone/Fax

Practice location:
  • Phone: 714-213-6678
  • Fax:
Mailing address:
  • Phone: 714-213-6678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF83172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: