Provider Demographics
NPI:1376875518
Name:RAJEEV KRISHAN M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RAJEEV KRISHAN M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-735-3915
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76632207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty