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General NPI Number Information
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NPI Number | 1811390743
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Entity Type | Organization
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Legal Business Name | STEMACT.INK
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Dates
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Enumeration Date | 10/06/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 22 ODYSSEY SUITE 155
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City | IRVINE
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State | CA
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Zip | 92618
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Country | US
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Telephone | 949-517-8188
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Fax | 949-381-5584
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Provider Business Mailing Address
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Address Line | 22 ODYSSEY STE 155
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City | IRVINE
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State | CA
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Zip | 92618-3194
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Country | US
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Telephone | 949-517-8188
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Fax | 949-381-5584
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Authorized Official
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Title or Position | LAC
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Name | MS. JIN HEE PARK
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Credential |
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Telephone | 949-517-8188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC 15771
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License Number State | CA
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