Provider Demographics
NPI:1922082452
Name:GROSS, KARYN LEIGH (MD)
Entity Type:Individual
Prefix:MS
First Name:KARYN
Middle Name:LEIGH
Last Name:GROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18411 CLARK ST
Mailing Address - Street 2:# 304
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3506
Mailing Address - Country:US
Mailing Address - Phone:818-342-0400
Mailing Address - Fax:818-342-7307
Practice Address - Street 1:18411 CLARK ST
Practice Address - Street 2:# 304
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3506
Practice Address - Country:US
Practice Address - Phone:818-342-0400
Practice Address - Fax:818-342-7307
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG44891207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92532Medicare UPIN
CAG44891Medicare ID - Type Unspecified