Provider Demographics
NPI:1104010073
Name:DR SUKHDEEP K GREWAL M.D.INC.
Entity Type:Organization
Organization Name:DR SUKHDEEP K GREWAL M.D.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUKHDEEP
Authorized Official - Middle Name:K
Authorized Official - Last Name:GREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-500-0198
Mailing Address - Street 1:PO BOX 28572
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-8572
Mailing Address - Country:US
Mailing Address - Phone:949-500-0198
Mailing Address - Fax:
Practice Address - Street 1:2701 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6201
Practice Address - Country:US
Practice Address - Phone:714-754-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA526362084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16921Medicare PIN