Provider Demographics
NPI:1689551095
Name:JI, MYUNG JU (AMFT)
Entity type:Individual
Prefix:MRS
First Name:MYUNG
Middle Name:JU
Last Name:JI
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S STATE COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4118
Mailing Address - Country:US
Mailing Address - Phone:703-399-9764
Mailing Address - Fax:
Practice Address - Street 1:3031 COLT WAY UNIT 231
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4943
Practice Address - Country:US
Practice Address - Phone:703-399-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148598106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist