Provider Demographics
NPI:1629062005
Name:VASHISTHA, KRISHAN KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHAN
Middle Name:KUMAR
Last Name:VASHISTHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27141 HIDAWAY AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-4131
Mailing Address - Country:US
Mailing Address - Phone:661-251-4783
Mailing Address - Fax:661-251-8245
Practice Address - Street 1:27141 HIDAWAY AVE
Practice Address - Street 2:STE 105
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-4131
Practice Address - Country:US
Practice Address - Phone:661-251-4783
Practice Address - Fax:661-251-8245
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31642208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A316420Medicaid