Provider Demographics
NPI:1811390743
Name:STEMACT.INK
Entity Type:Organization
Organization Name:STEMACT.INK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:MS
Authorized Official - First Name:JIN HEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-517-8188
Mailing Address - Street 1:22 ODYSSEY STE 155
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3194
Mailing Address - Country:US
Mailing Address - Phone:949-517-8188
Mailing Address - Fax:949-381-5584
Practice Address - Street 1:22 ODYSSEY
Practice Address - Street 2:SUITE 155
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-517-8188
Practice Address - Fax:949-381-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15771261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center