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General NPI Number Information
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NPI Number | 1568760239
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Entity Type | Organization
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Legal Business Name | SHINE HEALTHCARE INC.
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 07/28/2012
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Provider Practice Location Address
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Address Line | 12371 IMPERIAL HWY
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City | NORWALK
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State | CA
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Zip | 90650-3129
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Country | US
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Telephone | 562-929-5000
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Fax | 562-375-6286
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Provider Business Mailing Address
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Address Line | 12371 IMPERIAL HWY
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City | NORWALK
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State | CA
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Zip | 90650-3129
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Country | US
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Telephone | 562-929-5000
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Fax | 562-375-6286
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Authorized Official
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Title or Position | CEO
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Name | DR. PRAFUL SARODE
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Credential | M.D.
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Telephone | 562-929-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A43383
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | A43383
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | A43383
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | A43383
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | A43383
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A43383
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A43383
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License Number State | CA
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