Provider Demographics
NPI:1669558276
Name:KRISHNA, PAD S (MD)
Entity type:Individual
Prefix:
First Name:PAD
Middle Name:S
Last Name:KRISHNA
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 1:3650 E. SOUTH ST
Mailing Address - Street 2:SUITE 411
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1512
Mailing Address - Country:US
Mailing Address - Phone:562-531-7757
Mailing Address - Fax:562-531-0833
Practice Address - Street 1:3650 E. SOUTH ST
Practice Address - Street 2:SUITE 411
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1512
Practice Address - Country:US
Practice Address - Phone:562-531-7757
Practice Address - Fax:562-531-0833
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30918207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0656920001OtherDME
CAA84147Medicare UPIN
CAWA30918AMedicare PIN