Provider Demographics
NPI:1205868445
Name:TEWARI, KRISHNANSU SUJATA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISHNANSU
Middle Name:SUJATA
Last Name:TEWARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 513980
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-3980
Mailing Address - Country:US
Mailing Address - Phone:714-456-6431
Mailing Address - Fax:714-456-7754
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-6431
Practice Address - Fax:714-456-7754
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA601614207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG88718Medicare UPIN