MEDICARE: LEV GRINMAN MD 2 PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1871357996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEV GRINMAN MD 2 PC

Provider Business Mailing Address
First Line	:	3030 SAWTELLE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-1408
Country	:	US
Telephone Number	:	310-390-9018
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 NEW LOS ANGELES AVE STE 210
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-2089
Country	:	US
Telephone Number	:	844-776-6332
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WAYNE EICHI HIGASHI
Credential	:	DC
Telephone Number	:	310-980-9018

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	03/11/2026

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