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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