Provider Demographics
NPI:1295030096
Name:SURAPANENI, KRISHNA (MD)
Entity Type:Individual
Prefix:MR
First Name:KRISHNA
Middle Name:
Last Name:SURAPANENI
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 1:1000 S. ANAHEIM BLVD SUITE 300
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805
Mailing Address - Country:US
Mailing Address - Phone:714-399-0046
Mailing Address - Fax:714-399-0049
Practice Address - Street 1:1000 S ANAHEIM BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5804
Practice Address - Country:US
Practice Address - Phone:714-399-0046
Practice Address - Fax:714-399-0049
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49872207VG0400X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgery