Provider Demographics
NPI:1043526882
Name:S. KRISHNAN MD INC
Entity Type:Organization
Organization Name:S. KRISHNAN MD INC
Other - Org Name:SUBBARAYAN KRISHNAN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBBARAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-766-7030
Mailing Address - Street 1:1031 E LATHAM AVE
Mailing Address - Street 2:#3
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4425
Mailing Address - Country:US
Mailing Address - Phone:951-766-7030
Mailing Address - Fax:951-766-5800
Practice Address - Street 1:1031 E LATHAM AVE
Practice Address - Street 2:#3
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4425
Practice Address - Country:US
Practice Address - Phone:951-766-7030
Practice Address - Fax:951-766-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054481261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A544810OtherMEDICARE PTAN
CA4882835Medicaid
CA1023047198 01OtherMEDI-CAL PROVIDER NUMBER
CAG18844Medicare UPIN