Provider Demographics
NPI:1932251428
Name:ORLIN, I GRANT (MD)
Entity Type:Individual
Prefix:
First Name:I
Middle Name:GRANT
Last Name:ORLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3591 EMANUEL DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1133
Mailing Address - Country:US
Mailing Address - Phone:949-378-6694
Mailing Address - Fax:
Practice Address - Street 1:21707 HAWTHORNE BLVD
Practice Address - Street 2:PERFORMANCE HEALTH MEDICAL GROUP STE 101
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7010
Practice Address - Country:US
Practice Address - Phone:310-540-9699
Practice Address - Fax:310-540-9433
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22065208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA909482OtherQME
CA909482OtherQME
A89352Medicare UPIN