MEDICARE: RAVI KRISHNAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	C53892	CA
2	2080N0001X	Neonatal-Perinatal Medicine Physician	C53892	CA

General Provider Information

NPI Number	:	1588640197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVI KRISHNAN MD

Provider Business Mailing Address
First Line	:	1201 W. LA VETA AVE.
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4203
Country	:	US
Telephone Number	:	714-509-3096
Fax Number	:	714-509-7800

Provider Business Practice Location Address
First Line	:	1201 W. LA VETA AVE.
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4203
Country	:	US
Telephone Number	:	714-509-3096
Fax Number	:	714-509-7800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	01/11/2013

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Directions to “ RAVI KRISHNAN MD” Practice Location

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