Healthcare Provider Details

I. General information

NPI: 1790426849
Provider Name (Legal Business Name): SHANNON YOUNESSI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4836 VAN NUYS BLVD
SHERMAN OAKS CA
91403-2101
US

IV. Provider business mailing address

4037 SAN REMO WAY
TARZANA CA
91356-5701
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-7546
  • Fax: 818-907-9506
Mailing address:
  • Phone: 818-907-7546
  • Fax: 818-907-9506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA207183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: