Healthcare Provider Details

I. General information

NPI: 1891972758
Provider Name (Legal Business Name): JAY ARACKAL KRISHNAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAYAKRISHNAN ARACKAL KRISHNAKURUP

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8331 RESEDA BLVD
NORTHRIDGE CA
91324-4620
US

IV. Provider business mailing address

8331 RESEDA BLVD
NORTHRIDGE CA
91324-4620
US

V. Phone/Fax

Practice location:
  • Phone: 818-538-2562
  • Fax: 818-745-7249
Mailing address:
  • Phone: 818-538-2562
  • Fax: 818-745-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number19090
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: