Healthcare Provider Details

I. General information

NPI: 1942543699
Provider Name (Legal Business Name): CHRISTOPHER DAVID VERCAMMEN-GRANDJEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
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 NumberA135720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: