Provider Demographics
NPI:1649201823
Name:KRISHAN K GOEL MD INC.
Entity Type:Organization
Organization Name:KRISHAN K GOEL MD INC.
Other - Org Name:TURLOCK PEDIATRIC MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-667-0905
Mailing Address - Street 1:1100 DELBON AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2021
Mailing Address - Country:US
Mailing Address - Phone:209-667-0905
Mailing Address - Fax:209-667-0922
Practice Address - Street 1:1100 DELBON AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2021
Practice Address - Country:US
Practice Address - Phone:209-667-0905
Practice Address - Fax:209-667-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078290Medicaid