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General NPI Number Information
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NPI Number | 1881076313
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Entity Type | Individual
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Provider Name | KONSTANTIN VLADIMIR GRIGORYAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2015
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 2261 DOUGLAS BLVD
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City | ROSEVILLE
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State | CA
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Zip | 95661-3831
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Country | US
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Telephone | 916-791-0920
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Fax | 916-797-4767
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865-5228
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Country | US
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Telephone | 800-470-0071
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Fax | 916-854-6769
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | A169957
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 60753
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License Number State | MN
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