| Doctor Name: | DR. GRANT ADAM KIDD |
| NPI Number: | 1730167057 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 02002990A |
| Business Practice Address: | 238 Avenida Montalvo Unit B San Clemente, CA - 926724474 |
| Business Phone Number: | 9498856344 |
| Business Fax Number: | |
| Mailing Address: | 101 The City Dr S, ORANGE |
| State: | CA |
| Postal Code: | 928683201 |
| Phone Number: | 9498856344 |
| Fax Number: | |
| NPI Enumeration Date: | 01/06/2006 |
| NPI Last Update Date: | 08/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 02002990A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |