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General NPI Number Information
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NPI Number | 1689954695
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Entity Type | Individual
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Provider Name | VIVIAN PHAN SHIBAYAMA O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 200 STEIN PLAZA SUITE 2-525
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City | LOS ANGELES
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State | CA
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Zip | 90095-7065
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Country | US
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Telephone | 310-825-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 14290
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License Number State | CA
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