Healthcare Provider Details

I. General information

NPI: 1659281889
Provider Name (Legal Business Name): STELLA JIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6726 BEACH BLVD
BUENA PARK CA
90621-3410
US

IV. Provider business mailing address

10593 LAVENDER CIR
SANTA FE SPRINGS CA
90670-3861
US

V. Phone/Fax

Practice location:
  • Phone: 714-752-6698
  • Fax: 714-752-6538
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS018106
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: