Provider Demographics
NPI:1700807393
Name:GREWAL, KULJINDER SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:KULJINDER
Middle Name:SINGH
Last Name:GREWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8881 FLETCHER PARKWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3131
Mailing Address - Country:US
Mailing Address - Phone:619-644-1400
Mailing Address - Fax:619-644-1422
Practice Address - Street 1:8881 FLETCHER PARKWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3131
Practice Address - Country:US
Practice Address - Phone:619-644-1400
Practice Address - Fax:619-644-1422
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34108207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341080Medicaid
CAA34108Medicare ID - Type Unspecified
A27375Medicare UPIN
CA00A341080Medicaid