Provider Demographics
NPI:1497831978
Name:MALHOTRA, KRISHAN (MD)
Entity Type:Individual
Prefix:
First Name:KRISHAN
Middle Name:
Last Name:MALHOTRA
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 1:1902 ROYALTY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3030
Mailing Address - Country:US
Mailing Address - Phone:909-629-2290
Mailing Address - Fax:909-629-7278
Practice Address - Street 1:1902 ROYALTY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3030
Practice Address - Country:US
Practice Address - Phone:909-629-2290
Practice Address - Fax:909-629-7278
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38932207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A389320Medicaid
CAA38932Medicare ID - Type Unspecified
CAA28762Medicare UPIN