Provider Demographics
NPI:1437100898
Name:KRISHNA, ALOK (MD)
Entity Type:Individual
Prefix:
First Name:ALOK
Middle Name:
Last Name:KRISHNA
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 1:1141 SIBLEY ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3222
Mailing Address - Country:US
Mailing Address - Phone:916-569-8585
Mailing Address - Fax:916-640-0100
Practice Address - Street 1:1141 SIBLEY ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3222
Practice Address - Country:US
Practice Address - Phone:916-569-8585
Practice Address - Fax:916-640-0100
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55199101YA0400X, 207Q00000X
OH35082144207Q00000X
TXN0186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFI0976057OtherDEA
OH4100485Medicare PIN
H78270Medicare UPIN
OH4100486Medicare PIN
OHKR4100487Medicare PIN
OHP00619430Medicare PIN
OHKR4100487Medicare PIN
OH4100486Medicare PIN
OHP00619430Medicare PIN