Healthcare Provider Details

I. General information

NPI: 1699640367
Provider Name (Legal Business Name): SHAUN SHINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 IMPERIAL HWY
DOWNEY CA
90242-2813
US

IV. Provider business mailing address

820 INVERGARRY ST
GLENDORA CA
91741-3225
US

V. Phone/Fax

Practice location:
  • Phone: 562-922-7488
  • Fax:
Mailing address:
  • Phone: 626-233-5807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: