Healthcare Provider Details

I. General information

NPI: 1184751489
Provider Name (Legal Business Name): SHANNON LEIGH HENNIGAR L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WESTCLIFF DR STE 200
NEWPORT BEACH CA
92660-5518
US

IV. Provider business mailing address

7561 CENTER AVE STE 27B
HUNTINGTON BEACH CA
92647-3037
US

V. Phone/Fax

Practice location:
  • Phone: 949-300-2028
  • Fax:
Mailing address:
  • Phone: 714-609-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 10255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: