Provider Demographics
NPI:1083843460
Name:SAMUEL SUNSHINE MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SAMUEL SUNSHINE MD MEDICAL CORPORATION
Other - Org Name:OC SPORTS AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNSHINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-460-9111
Mailing Address - Street 1:26700 TOWNE CENTRE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2843
Mailing Address - Country:US
Mailing Address - Phone:949-460-9111
Mailing Address - Fax:949-460-9055
Practice Address - Street 1:26700 TOWNE CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2843
Practice Address - Country:US
Practice Address - Phone:949-460-9111
Practice Address - Fax:949-460-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77348207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF72969Medicare UPIN