Provider Demographics
NPI:1437260684
Name:GROSSMAN, KARUN F (MD)
Entity Type:Individual
Prefix:
First Name:KARUN
Middle Name:F
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2210 DEL PASO RD
Practice Address - Street 2:#A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-9671
Practice Address - Country:US
Practice Address - Phone:916-285-8100
Practice Address - Fax:916-285-8115
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A884130Medicaid
CA00A884130Medicaid
CA00A884132Medicare PIN