Provider Demographics
NPI:1265630982
Name:GREWAL, KIRAT K (MD)
Entity Type:Individual
Prefix:
First Name:KIRAT
Middle Name:K
Last Name:GREWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRAT
Other - Middle Name:K
Other - Last Name:MALHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1650 PACIFIC COAST HWY STE B
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6253
Mailing Address - Country:US
Mailing Address - Phone:562-439-5480
Mailing Address - Fax:
Practice Address - Street 1:1650 PACIFIC COAST HWY STE B
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6253
Practice Address - Country:US
Practice Address - Phone:714-794-9410
Practice Address - Fax:657-215-6569
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92116208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics