Healthcare Provider Details

I. General information

NPI: 1902465792
Provider Name (Legal Business Name): PACIFIC HEART & VASCULAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 W. CHAPMAN AVE STE #101
ORANGE CA
92868-2862
US

IV. Provider business mailing address

1234 W. CHAPMAN AVE STE #101
ORANGE CA
92868-2862
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-6713
  • Fax: 714-532-1169
Mailing address:
  • Phone: 714-532-6713
  • Fax: 714-532-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SENDHIL K KRISHNAN
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 813-368-8814