Provider Demographics
NPI:1609953314
Name:YI, JUNG MIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUNG
Middle Name:MIN
Last Name:YI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 HILLDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1316
Mailing Address - Country:US
Mailing Address - Phone:312-933-3173
Mailing Address - Fax:
Practice Address - Street 1:726 HILLDALE AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94708-1316
Practice Address - Country:US
Practice Address - Phone:312-933-3173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019859103TC0700X
CAPSY25586103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical