Provider Demographics
NPI:1982776852
Name:GROVER, SANJAY (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:GROVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20360 SW BIRCH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1532
Mailing Address - Country:US
Mailing Address - Phone:949-759-9551
Mailing Address - Fax:949-706-5624
Practice Address - Street 1:20360 SW BIRCH ST STE 120
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1532
Practice Address - Country:US
Practice Address - Phone:949-759-9551
Practice Address - Fax:949-706-5624
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54558208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery