Provider Demographics
NPI:1376693325
Name:KRISHNAN, SENDHIL K (MD, FACC)
Entity Type:Individual
Prefix:
First Name:SENDHIL
Middle Name:K
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 W CHAPMAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2862
Mailing Address - Country:US
Mailing Address - Phone:714-984-0548
Mailing Address - Fax:714-245-0260
Practice Address - Street 1:1234 W CHAPMAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2862
Practice Address - Country:US
Practice Address - Phone:714-984-0548
Practice Address - Fax:714-245-0260
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96571207R00000X
CAA130341207RI0011X
MO2011015398207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095890Medicaid
CAGR0095890Medicaid
MO502200011Medicare Oscar/Certification
FLAA607YMedicare PIN
FL91983OtherBCBS
MO1376693325Medicaid