Provider Demographics
NPI:1114385648
Name:SHINING STARS
Entity Type:Organization
Organization Name:SHINING STARS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, M.S./CCC-SLP
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-704-6791
Mailing Address - Street 1:17215 STUDEBAKER RD.
Mailing Address - Street 2:#180
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703
Mailing Address - Country:US
Mailing Address - Phone:562-704-6791
Mailing Address - Fax:562-704-6783
Practice Address - Street 1:17215 STUDEBAKER RD.
Practice Address - Street 2:#180
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703
Practice Address - Country:US
Practice Address - Phone:562-704-6791
Practice Address - Fax:562-704-6783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 21934235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty