Healthcare Provider Details

I. General information

NPI: 1700708591
Provider Name (Legal Business Name): AKHIL KRISHNAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8167 W 3RD ST
LOS ANGELES CA
90048-4314
US

IV. Provider business mailing address

1653 ENTERPRISE
SAN PEDRO CA
90732-6105
US

V. Phone/Fax

Practice location:
  • Phone: 323-655-2023
  • Fax:
Mailing address:
  • Phone: 310-986-9527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number6072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: