Healthcare Provider Details

I. General information

NPI: 1750008017
Provider Name (Legal Business Name): SUNNY HILLS MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E COMMONWEALTH AVE STE 100
FULLERTON CA
92832-1905
US

IV. Provider business mailing address

140 E COMMONWEALTH AVE STE 100
FULLERTON CA
92832-1905
US

V. Phone/Fax

Practice location:
  • Phone: 714-572-3900
  • Fax: 714-572-4300
Mailing address:
  • Phone: 714-572-3900
  • Fax: 714-572-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDHYA GUDAPATI
Title or Position: PRESIDENT
Credential: MD
Phone: 714-773-4111