Provider Demographics
NPI:1942506530
Name:GRABOW MEDICAL GROUP
Entity type:Organization
Organization Name:GRABOW MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-242-4224
Mailing Address - Street 1:DEPT LA 23881
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-0001
Mailing Address - Country:US
Mailing Address - Phone:714-242-4224
Mailing Address - Fax:714-380-6300
Practice Address - Street 1:400 N TUSTIN AVE
Practice Address - Street 2:SUITE 470
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3813
Practice Address - Country:US
Practice Address - Phone:714-242-4224
Practice Address - Fax:714-380-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66481207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA616223700 SANTA ANAOtherUS DEPARTMENT OF LABOR PROVIDER #
CAG66481OtherMEDICAL LICENSE
CA1629089529OtherPHYSICIAN'S NPI
CA616223700 SANTA ANAOtherUS DEPARTMENT OF LABOR PROVIDER #