Healthcare Provider Details

I. General information

NPI: 1073561098
Provider Name (Legal Business Name): GERALD GROSSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 WILSHIRE BLVD STE 100
BEVERLY HILLS CA
90211-2708
US

IV. Provider business mailing address

935 S SUNSET AVE
WEST COVINA CA
91790-3408
US

V. Phone/Fax

Practice location:
  • Phone: 310-689-3100
  • Fax:
Mailing address:
  • Phone: 805-522-5940
  • Fax: 805-522-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG22345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: