Healthcare Provider Details

I. General information

NPI: 1538556592
Provider Name (Legal Business Name): DENNIS GREWAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BACHITER GREWAL MD

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N TUSTIN AVE
SANTA ANA CA
92705-3602
US

IV. Provider business mailing address

700 N TUSTIN AVE
SANTA ANA CA
92705-3602
US

V. Phone/Fax

Practice location:
  • Phone: 714-245-1444
  • Fax: 714-245-1444
Mailing address:
  • Phone: 714-245-1444
  • Fax: 714-953-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A15476
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: