Healthcare Provider Details

I. General information

NPI: 1982555405
Provider Name (Legal Business Name): STACY LYNN KIRIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 CEDAR AVE
EL MONTE CA
91732-1099
US

IV. Provider business mailing address

4921 CEDAR AVE
EL MONTE CA
91732-1099
US

V. Phone/Fax

Practice location:
  • Phone: 626-444-9201
  • Fax:
Mailing address:
  • Phone: 626-444-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220042070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: