Healthcare Provider Details

I. General information

NPI: 1114385648
Provider Name (Legal Business Name): SHINING STARS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 STUDEBAKER RD. #180
CERRITOS CA
90703
US

IV. Provider business mailing address

17215 STUDEBAKER RD. #180
CERRITOS CA
90703
US

V. Phone/Fax

Practice location:
  • Phone: 562-704-6791
  • Fax: 562-704-6783
Mailing address:
  • Phone: 562-704-6791
  • Fax: 562-704-6783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 21934
License Number StateCA

VIII. Authorized Official

Name: JULIA YI
Title or Position: OWNER, M.S./CCC-SLP
Credential:
Phone: 562-704-6791