Healthcare Provider Details

I. General information

NPI: 1740509710
Provider Name (Legal Business Name): KHUSHDEEP KAUR GREWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 TROUSDALE DR
BURLINGAME CA
94010-4506
US

IV. Provider business mailing address

2001 WINWARD WAY STE 101
SAN MATEO CA
94404-2499
US

V. Phone/Fax

Practice location:
  • Phone: 650-696-3520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.124005
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA139099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: