Organization Active NPI

Sunshine Kids Medical Associates Inc

  • Pediatrics Physician
  • Garden Grove, CA
National Provider Identifier
1003991373
Registry record updated Apr 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SUNSHINE KIDS MEDICAL ASSOCIATES INC
Practice address
12665 Garden Grove Blvd
#604
Garden Grove, CA 92843-1917
Phone
(714) 537-8777
Fax
(714) 537-8111
NPI assigned
Oct 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Shelley Y Lee, MDNPI 1144325259
Title
President
Phone
(714) 537-8777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

12665 Garden Grove Blvd
#604
Garden Grove, CA 92843-1917

Mailing address

12665 Garden Grove Blvd
#604
Garden Grove, CA 92843-1917
Phone (714) 537-8777

Other identifiers 1

IdentifierTypeStateIssuer
GR0091600MedicaidCA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0971827Sunshine Kids Medical Associates, Inc12665 Garden Grove Blvd Ste 604, Garden Grove, CA 92843Certificate of waiverMar 21, 2028

National Provider Directory

National Provider Directory

Locations

12665 Garden Grove Blvd
Ste 604
Garden Grove, CA 92843
Phone (714) 537-8777

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397088000000",
    "number": "1003991373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD",
            "address_2": "#604",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431917",
            "telephone_number": "714-537-8777",
            "fax_number": "714-537-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD",
            "address_2": "#604",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431917",
            "telephone_number": "714-537-8777",
            "fax_number": "714-537-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNSHINE KIDS MEDICAL ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2014-04-10",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-537-8777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091600",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.