Provider Demographics
NPI:1356438568
Name:KRISHNA NARAYANAN, M. D. PROFESSIONAL CORP
Entity type:Organization
Organization Name:KRISHNA NARAYANAN, M. D. PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAYANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-888-2323
Mailing Address - Street 1:641 S SANTA ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1419
Mailing Address - Country:US
Mailing Address - Phone:323-888-2323
Mailing Address - Fax:323-888-1553
Practice Address - Street 1:101 E BEVERLY BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4300
Practice Address - Country:US
Practice Address - Phone:323-888-2323
Practice Address - Fax:323-888-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA067018208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A670180Medicaid
CAA67018Medicare ID - Type Unspecified