Healthcare Provider Details

I. General information

NPI: 1679742241
Provider Name (Legal Business Name): ANNE N. SHIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5269 LANKERSHIM BLVD
N HOLLYWOOD CA
91601-3111
US

IV. Provider business mailing address

1247 19TH ST
HERMOSA BEACH CA
90254-3309
US

V. Phone/Fax

Practice location:
  • Phone: 818-769-2024
  • Fax:
Mailing address:
  • Phone: 213-709-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 12595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: