Provider Demographics
NPI:1033124854
Name:KRISHAN, RAJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJEEV
Middle Name:
Last Name:KRISHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 STOCKDALE HWY STE 208
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3634
Mailing Address - Country:US
Mailing Address - Phone:661-735-3915
Mailing Address - Fax:661-735-3919
Practice Address - Street 1:9900 STOCKDALE HWY STE 208
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3634
Practice Address - Country:US
Practice Address - Phone:661-735-3915
Practice Address - Fax:661-735-3919
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76632174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A766320Medicaid
CA00A766320Medicaid
CA00A766320Medicare ID - Type UnspecifiedMEDICARE