Shannon Wongvibulsin

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A181956 Issued in CA

Practice address

101 The City Dr S
Orange, CA 92868-3201

Phone

(714) 456-8888

NPI assigned

Dec 31, 2015

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1451520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782864000000",
    "number": "1144685447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "733 RUTLAND AVE.",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212052109",
            "telephone_number": "410-955-3080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-456-8888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Lothrop St",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152132536",
            "country_code": "US",
            "telephone_number": "412-692-4942",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 N Wolfe St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212870005",
            "country_code": "US",
            "telephone_number": "410-955-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONGVIBULSIN",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-31",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A181956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachael Sze Nga Wong
• Ryan Wong, M.D.
• Siu-Fun Wong, PHARM.D.
• Susan Wong, M.D.
• Tammy Wong
• Dustin Woo
• Daneeka Wood, ASW
• Justine Wood
• Katherine Leigh Wood, MD
• Samantha Wood

• Dermatology Physician in Orange, CA
• Providers in Orange, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.