Provider Demographics
NPI:1942542899
Name:RYU-LEE, EUN JIN
Entity Type:Individual
Prefix:
First Name:EUN JIN
Middle Name:
Last Name:RYU-LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:UN JIN
Other - Middle Name:
Other - Last Name:RYU KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4811 EUREKA AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3368
Mailing Address - Country:US
Mailing Address - Phone:714-213-6678
Mailing Address - Fax:
Practice Address - Street 1:4811 EUREKA AVE STE B3
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3368
Practice Address - Country:US
Practice Address - Phone:714-213-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF83172106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist