Kids Critical Care Medical Group Inc

Primary specialty

Children's HospitalTaxonomy code 282NC2000X

License

047879 Issued in CA

Legal business name

KIDS CRITICAL CARE MEDICAL GROUP INC

Practice address

1111 West la Palma Ave
Anaheim Memorial Medical Center
Anaheim, CA 92801-2881

Phone

(714) 999-5144

Fax

(714) 999-5143

NPI assigned

Oct 31, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sandy S Shaw, MD

Title

President

Phone

(714) 999-5144

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kids Care Med Group Inc Former legal business name

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528144763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2217",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92837",
            "telephone_number": "714-999-5144",
            "fax_number": "714-999-5143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 WEST LA PALMA AVE",
            "address_2": "ANAHEIM MEMORIAL MEDICAL CENTER",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012881",
            "telephone_number": "714-999-5144",
            "fax_number": "714-999-5143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS CRITICAL CARE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "SANDY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-999-5144",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": "CA",
            "license": "047879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "GR0046500",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids Care Med Group Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Lauren Kidd, MA
• Kids Care Pediatrics Medical Group, Inc.
• Kietnguyen DMD Corp (Kiet Nguyen DMD)
• Dao A. Kieu, MD
• Paige Kikawa
• Eileen Kil
• Suheir Kilani, PA-C

• Children's Hospital in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Children's Hospital in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.