Healthcare Provider Details

I. General information

NPI: 1679469951
Provider Name (Legal Business Name): KRISTINE SHAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 YORBA LINDA BLVD STE 250
YORBA LINDA CA
92886-4044
US

IV. Provider business mailing address

3191 HAMPTON DR
WEST COVINA CA
91791-3487
US

V. Phone/Fax

Practice location:
  • Phone: 714-577-6000
  • Fax:
Mailing address:
  • Phone: 626-862-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: