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Organization
KIDS CRITICAL CARE MEDICAL GROUP INC
Active
Organization
KIDS CRITICAL CARE MEDICAL GROUP INC
Active
Other names
Kids Care Med Group Inc
Organization subpart
No
Provider details
NPI number
Authorized official
SANDY S SHAW MD (PRESIDENT)
(714) 999-5144
Entity
Organization
Contact information
Practice address
1111 WEST LA PALMA AVE, ANAHEIM MEMORIAL MEDICAL CENTER, ANAHEIM, CA 92801-2881
(714) 999-5144
(714) 999-5143
Mailing address
PO BOX 2217, FULLERTON, CA 92837
(714) 999-5144
(714) 999-5143
Taxonomy
Speciality
Code
Description
License number
State
282NC2000X
Children's Hospital
Primary
047879
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0046500
MEDICAL
CA
Enumeration date
10/31/2006
Last updated
08/22/2020
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