Shirley Lynne Van, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G51607 Issued in CA

Practice address

862 Aerovista PL Ste 100
San Luis Obispo, CA 93401-8758

Phone

(805) 549-8023

Fax

(805) 549-8252

NPI assigned

Mar 27, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, IL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Dermatology

Education

University of Miami, LM Miller School of Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: svan1443388@direct.uclahealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Soderstrom Dermatology Center S C

  • Dermatology Physician
  • Peoria, IL
  • NPI 1710931670
  Medicare reassignment NPD
• Soderstrom Dermatology Center S C

  • Ambulatory Surgical Clinic/Center
  • Peoria, IL
  • NPI 1053362343
  NPD
• West Dermatology of Northern California, Inc

  • Procedural Dermatology Physician
  • Modesto, CA
  • NPI 1568523793
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1063530749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "862 AEROVISTA PL STE 100",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934018758",
            "telephone_number": "805-549-8023",
            "fax_number": "805-549-8252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26800 Crown Valley Pkwy Ste 435",
            "address_purpose": "LOCATION",
            "city": "Mission Viejo",
            "state": "CA",
            "postal_code": "926918023",
            "country_code": "US",
            "telephone_number": "949-573-9510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN",
        "first_name": "SHIRLEY",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G51607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Van Brasch
• William Van Dorn
• David P. Van Dyke, D.C.
• Steven Clark Van Scoy, M.D.
• Carolina Anne Van Stone, PH.D.-TRAINEE
• Vance D. Rodgers, M.D., Inc.
• Heidi Annette Vance, MSW, ACSW
• Caledonia Vanden Bossche
• Ginger Diane Vandenandel
• Melanie Ruth Vann

• Dermatology Physician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.