Healthcare Provider Details

I. General information

NPI: 1134259104
Provider Name (Legal Business Name): KARYN L GROSSMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SANTA MONICA BLVD STE 1250W
SANTA MONICA CA
90404-2217
US

IV. Provider business mailing address

2001 SANTA MONICA BLVD. SUITE 1250W
SANTA MONICA CA
90404-2217
US

V. Phone/Fax

Practice location:
  • Phone: 310-998-0040
  • Fax:
Mailing address:
  • Phone: 310-998-0040
  • Fax: 310-998-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG084212
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number199318
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG084212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: