Provider Demographics
NPI:1194747246
Name:JIN, EUN KYUNG (MFT)
Entity type:Individual
Prefix:MS
First Name:EUN KYUNG
Middle Name:
Last Name:JIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:JIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:180 S LAKE AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2668
Mailing Address - Country:US
Mailing Address - Phone:626-755-5238
Mailing Address - Fax:
Practice Address - Street 1:180 S LAKE AVE STE 320
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2668
Practice Address - Country:US
Practice Address - Phone:626-755-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist