MEDICARE: JI YUN NAM

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	103TC0700X	Clinical Psychologist	31479	CA

General Provider Information

NPI Number	:	1982159349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JI YUN NAM

Provider Business Mailing Address
First Line	:	21143 HAWTHORNE BLVD # 241
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503-4615
Country	:	US
Telephone Number	:	310-845-6151
Fax Number	:

Provider Business Practice Location Address
First Line	:	10061 TALBERT AVE STE 200
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5123
Country	:	US
Telephone Number	:	310-845-6151
Fax Number	:

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

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	12/30/2025

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Directions to “ JI YUN NAM ” Practice Location

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