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General NPI Number Information
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NPI Number | 1114385648
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Entity Type | Organization
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Legal Business Name | SHINING STARS
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 17215 STUDEBAKER RD. #180
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City | CERRITOS
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State | CA
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Zip | 90703
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Country | US
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Telephone | 562-704-6791
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Fax | 562-704-6783
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Provider Business Mailing Address
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Address Line | 17215 STUDEBAKER RD. #180
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City | CERRITOS
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State | CA
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Zip | 90703
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Country | US
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Telephone | 562-704-6791
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Fax | 562-704-6783
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Authorized Official
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Title or Position | OWNER, M.S./CCC-SLP
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Name | JULIA YI
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Credential |
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Telephone | 562-704-6791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP 21934
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License Number State | CA
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