Healthcare Provider Details

I. General information

NPI: 1659043388
Provider Name (Legal Business Name): SHERRY XUANMING SHANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 E LA PALMA AVE
ANAHEIM CA
92807-2023
US

IV. Provider business mailing address

18801 SHERBOURNE PL
ROWLAND HEIGHTS CA
91748-4865
US

V. Phone/Fax

Practice location:
  • Phone: 714-493-7593
  • Fax:
Mailing address:
  • Phone: 626-373-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number35019
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: