Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A55575 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | A55575 | CA |
NPI | 1639166523 |
---|---|
Provider Name | Dr. Atul Grover |
First Address | Newport Beach, CA 92663-4162 |
Second Address | Newport Beach, CA 92663-4162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 11/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A555750 | (05) | CA |