Healthcare Provider Details

I. General information

NPI: 1154299949
Provider Name (Legal Business Name): SUNSHINE PEDIATRICS OC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17877 VON KARMAN AVE STE 210
IRVINE CA
92614-4227
US

IV. Provider business mailing address

17877 VON KARMAN AVE STE 210
IRVINE CA
92614-4227
US

V. Phone/Fax

Practice location:
  • Phone: 949-617-2525
  • Fax: 949-617-3535
Mailing address:
  • Phone: 949-617-2525
  • Fax: 949-617-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JIYEON KIM
Title or Position: VP, COO
Credential: MD
Phone: 309-648-9816