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SHANE WALLIN
NPI 1104282177
Specialist/Technologist, Other - Art, Medical in San Diego, CA

Active since January 06, 2016
1968 GARNET AVE, SAN DIEGO, CA 92109(612) 214-1325 Get Directions Write a Review

NPPES record last updated: July 3, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 3, 2025, Aug 7, 2019, Nov 28, 2018 and 1 more (4 updates tracked since 2016).

About Shane Wallin NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANE WALLIN (NPI 1104282177) is an individual art, medical provider in San Diego, California, licensed in Minnesota (310143) and active in the NPI registry since January 2016. He maintains 2 additional practice locations.

NPPES Registry Identity

NPI1104282177
Entity TypeIndividualMale
Primary Taxonomy246ZA2600X
Provider Legal NameSHANE WALLIN
Location Address1968 GARNET AVESan Diego, CA 92109-3555
Mailing Address1968 Garnet AveSan Diego, CA 92109-3555 · (619) 942-9737
Phone(612) 214-1325
Sole ProprietorYes
Enumeration DateJanuary 6, 2016
Last NPPES UpdateJuly 3, 20254 updates tracked since enumeration
NPPES CertifiedJuly 3, 2025
✔ NPI 1104282177 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialist/Technologist, Other · Art, MedicalTechnologists, Technicians & Other Technical Service Providers
Taxonomy Code246ZA2600X
License✔ Licensed in MN · 310143
1968 GARNET AVE, San Diego, CA 92109
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Secondary Practice Locations 2

Location 13073 Jefferson StNapa, CA 94558-4921 · Phone (619) 942-9737
Location 24933 34th Ave SMinneapolis, MN 55417-1503 · Phone (619) 942-9737

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GARNET TATTOO
Specialist/Technologist, Other (Art, Medical)
1968 GARNET AVE
SAN DIEGO, CA 92109
San Diego County (619) 942-9737

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shane Wallin's NPI number?

The NPI number for Shane Wallin is 1104282177. It was assigned to this individual provider in the NPPES registry on January 6, 2016.

Where is Shane Wallin located?

Shane Wallin practices at 1968 Garnet Ave, San Diego, CA 92109. The listed phone number is (612) 214-1325.

What is Shane Wallin's specialty?

The primary specialty registered for this NPI is Specialist/Technologist, Other, specializing in Art, Medical, with taxonomy code 246ZA2600X.

When was this NPI record last updated?

The NPPES record for Shane Wallin was last updated on July 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.