Provider Demographics
NPI:1619161452
Name:JAMES, SOON Y (PSYCHOLOGY INTERN)
Entity Type:Individual
Prefix:
First Name:SOON
Middle Name:Y
Last Name:JAMES
Suffix:
Gender:M
Credentials:PSYCHOLOGY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-1612
Mailing Address - Country:US
Mailing Address - Phone:310-352-6422
Mailing Address - Fax:310-352-6480
Practice Address - Street 1:639 SOUTH COMMONWEATH
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005
Practice Address - Country:US
Practice Address - Phone:213-385-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist