National Provider Identifier Database

GRAND OB GYN MEDICAL GROUP INC
Gynecologic Oncology

An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications.


Contact Information

GRAND OB-GYN MEDICAL GROUP INC
4950 SAN BERNARDINO ST
SUTE 106
MONTCLAIR, CA91763-2328
Phone: 909-625-0615
Fax: 909-621-6735
Website:
Specialty Taxonomy Code
* Gynecologic Oncology 207VX0201X
Maternal & Fetal Medicine 207VM0101X
Reproductive Endocrinology 207VE0102X
Surgery 208600000X

* Indicates primary specialty

NPI Profile & details for GRAND OB-GYN MEDICAL GROUP INC

NPI Number 1043571599
Legal business name
LBN
GRAND OB-GYN MEDICAL GROUP INC
Authorized official THOMAS LEE - (MEDICAL DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 05/31/2012
Last updated 06/01/2012 - About 14 years ago
Sole proprietor1 Not specified
Identifiers
  • CA License #: A37294
  • CA Medicaid: 1477763829

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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