Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

SHANNON WONGVIBULSIN
NPI 1144685447
Dermatology in Orange, CA

Active since December 31, 2015PECOS Enrolled
101 THE CITY DR S, ORANGE, CA 92868(714) 456-8888 Get Directions Write a Review

NPPES record last updated: July 1, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Jun 15, 2021, Dec 31, 2015 (2 updates tracked since 2015).

About Shannon Wongvibulsin NPPES

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

SHANNON WONGVIBULSIN (NPI 1144685447) is an individual dermatology provider in Orange, California, licensed in California (A181956) and active in the NPI registry since December 2015. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1144685447
Entity TypeIndividualFemale
Primary Taxonomy207N00000X
Provider Legal NameSHANNON WONGVIBULSIN
Location Address101 THE CITY DR SOrange, CA 92868-3201
Mailing Address733 Rutland Ave.Baltimore, MD 21205-2109 · (410) 955-3080
Sole ProprietorNo
Enumeration DateDecember 31, 2015
Last NPPES UpdateJuly 1, 20262 updates tracked since enumeration
NPPES CertifiedJuly 1, 2026
NPI 1144685447 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License Licensed in CA · A181956
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
101 THE CITY DR S, Orange, CA 92868

Secondary Practice Locations 2

Location 1200 Lothrop StPittsburgh, PA 15213-2536 · Phone (412) 692-4942
Location 2600 N Wolfe StBaltimore, MD 21287-0005 · Phone (410) 955-5000

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Shannon Wongvibulsin is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92868 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

Radiology (Diagnostic Radiology)
101 THE CITY DR S
ORANGE, CA 92868
Obstetrics & Gynecology
101 THE CITY DR S, BUILDING 56, DEPARTMENT OF OB/GYN
ORANGE, CA 92868
Internal Medicine (Rheumatology)
101 THE CITY DR S
ORANGE, CA 92868
Plastic Surgery
101 THE CITY DR S
ORANGE, CA 92868
Emergency Medicine
101 THE CITY DR S, BUILDING 1A, ROOM 1009
ORANGE, CA 92868
Psychiatry & Neurology (Neurology)
101 THE CITY DR S, CITY TOWER, SUITE 400
ORANGE, CA 92868
Surgery (Trauma Surgery)
101 THE CITY DR S
ORANGE, CA 92868
Emergency Medicine
101 THE CITY DR S
ORANGE, CA 92868

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 Shannon Wongvibulsin's NPI number?

The NPI number for Shannon Wongvibulsin is 1144685447. It was assigned to this individual provider in the NPPES registry on December 31, 2015.

Where is Shannon Wongvibulsin located?

Shannon Wongvibulsin practices at 101 The City Dr S, Orange, CA 92868. The listed phone number is (714) 456-8888.

What is Shannon Wongvibulsin's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Shannon Wongvibulsin enrolled in Medicare?

Yes. Shannon Wongvibulsin is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Shannon Wongvibulsin was last updated on July 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 59 days 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.