Provider Demographics
NPI:1497940712
Name:KRISHNAN, PRIYANKA BHAT (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:BHAT
Last Name:KRISHNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23141 MOULTON PARKWAY STE 102
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-916-9100
Mailing Address - Fax:949-916-0091
Practice Address - Street 1:23141 MOULTON PARKWAY STE 102
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-916-9100
Practice Address - Fax:949-916-0091
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011020924207RE0101X
CAA130175207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9024702OtherAETNA
MO1497940712Medicaid
MOP01000140OtherRAIL ROAD MEDICARE
FL008787800Medicaid
FL14MJ4OtherFLORIDA BLUE
FL0821154OtherCIGNA
FLP01164119OtherRR MEDICARE GROUP DT5990
FL14MJ4OtherFLORIDA BLUE
FL0821154OtherCIGNA