Pediatric Care Medical Group, Inc.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A24153 Issued in CA

Legal business name

PEDIATRIC CARE MEDICAL GROUP, INC.

Practice address

17822 Beach Blvd
Suite 278
Huntington Beach, CA 92647-7101

Phone

(714) 842-1441

Fax

(714) 843-0394

NPI assigned

Jun 22, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Paul Y Qaqundah, M.D.

Title

President

Phone

(714) 842-1441

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851337356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17822 BEACH BLVD",
            "address_2": "SUITE 278",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926477101",
            "telephone_number": "714-842-1441",
            "fax_number": "714-843-0394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17822 BEACH BLVD",
            "address_2": "SUITE 278",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926477101",
            "telephone_number": "714-842-1441",
            "fax_number": "714-843-0394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC CARE MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "QAQUNDAH",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-842-1441",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A24153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0025680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sherry Peck, OTR/L
• Farzin Benjamin Pedouim, M.D.
• Johnnie Peeples Jr., CATC- I COUNSELOR
• Scott M Peifer, DDS
• Kimberly Peirson, M.D.
• Allyson Pelletier

• Pediatrics Physician in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Pediatrics Physician 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.