MEDICARE: EUN JIN RYU-LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF83172	CA

General Provider Information

NPI Number	:	1942542899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUN JIN RYU-LEE

Provider Business Mailing Address
First Line	:	4811 EUREKA AVE STE B3
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-3368
Country	:	US
Telephone Number	:	714-213-6678
Fax Number	:

Provider Business Practice Location Address
First Line	:	4811 EUREKA AVE STE B3
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-3368
Country	:	US
Telephone Number	:	714-213-6678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	09/11/2021

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Directions to “ EUN JIN RYU-LEE ” Practice Location

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