Healthcare Provider Details

I. General information

NPI: 1699694794
Provider Name (Legal Business Name): CDVG MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 S KENSINGTON RD
ORANGE CA
92869-5147
US

IV. Provider business mailing address

563 S KENSINGTON RD
ORANGE CA
92869-5147
US

V. Phone/Fax

Practice location:
  • Phone: 619-865-9156
  • Fax:
Mailing address:
  • Phone: 619-865-9156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER DAVID VERCAMMEN-GRANDJEAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 619-865-9156