Healthcare Provider Details

I. General information

NPI: 1396488623
Provider Name (Legal Business Name): SEQUOIA MULTISPECIALTY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 S DEMAREE ST
VISALIA CA
93277-9476
US

IV. Provider business mailing address

PO BOX 6005
VISALIA CA
93290-6005
US

V. Phone/Fax

Practice location:
  • Phone: 559-713-6478
  • Fax: 559-345-9667
Mailing address:
  • Phone: 559-713-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KEALANI KANEHE SINE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-713-6478