Healthcare Provider Details

I. General information

NPI: 1568154458
Provider Name (Legal Business Name): KRISHNA S HANUBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 23
ORANGE CA
92868-3201
US

IV. Provider business mailing address

6410 FANNIN ST STE 1400
HOUSTON TX
77030-5389
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8000
  • Fax:
Mailing address:
  • Phone: 832-325-7125
  • Fax: 713-512-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA200020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: