Provider Demographics
NPI:1730719170
Name:EMI IIJIMA, PSY.D.
Entity type:Organization
Organization Name:EMI IIJIMA, PSY.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EMI
Authorized Official - Middle Name:
Authorized Official - Last Name:IIJIMA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:323-972-7459
Mailing Address - Street 1:2001 S BARRINGTON AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5379
Mailing Address - Country:US
Mailing Address - Phone:323-972-7459
Mailing Address - Fax:
Practice Address - Street 1:2221 LINCOLN PARK AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2920
Practice Address - Country:US
Practice Address - Phone:323-276-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty