Provider Demographics
NPI:1083666051
Name:MANVI, KRISHNA N (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:N
Last Name:MANVI
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 1:4712 E 2ND ST # 533
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5309
Mailing Address - Country:US
Mailing Address - Phone:562-342-3001
Mailing Address - Fax:562-342-3001
Practice Address - Street 1:2776 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2613
Practice Address - Country:US
Practice Address - Phone:562-595-1911
Practice Address - Fax:562-595-1911
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25713207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77353ZMedicaid
CAWA25713DMedicare ID - Type Unspecified
CAZZZ77353ZMedicaid