Provider Demographics
NPI:1003991373
Name:SUNSHINE KIDS MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:SUNSHINE KIDS MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-537-8777
Mailing Address - Street 1:12665 GARDEN GROVE BLVD
Mailing Address - Street 2:#604
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1917
Mailing Address - Country:US
Mailing Address - Phone:714-537-8777
Mailing Address - Fax:714-537-8111
Practice Address - Street 1:12665 GARDEN GROVE BLVD
Practice Address - Street 2:#604
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1917
Practice Address - Country:US
Practice Address - Phone:714-537-8777
Practice Address - Fax:714-537-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0091600Medicaid