Healthcare Provider Details

I. General information

NPI: 1619853942
Provider Name (Legal Business Name): SHANNON CHEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5414 WALNUT AVE STE B
IRVINE CA
92604-2522
US

IV. Provider business mailing address

5414 WALNUT AVE STE B
IRVINE CA
92604-2522
US

V. Phone/Fax

Practice location:
  • Phone: 949-262-9393
  • Fax:
Mailing address:
  • Phone: 949-262-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: