Individual
KENNETH E. GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1201 W LA VETA AVE, ORANGE, CA 92868-4203
(714) 509-4099
(714) 509-4063
Mailing address
1201 W LA VETA AVE, ORANGE, CA 92868-4203
(714) 509-4099
(714) 509-4063
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
G60289
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G165430
—
CA
Enumeration date
10/02/2006
Last updated
01/30/2014
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