Healthcare Provider Details

I. General information

NPI: 1164602496
Provider Name (Legal Business Name): KRISHAN S. KHURANA MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2007
Last Update Date: 11/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 E FRUIT ST SUITE #216
SANTA ANA CA
92701-4459
US

IV. Provider business mailing address

2220 E FRUIT ST SUITE #216
SANTA ANA CA
92701-4459
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-0969
  • Fax: 714-547-4220
Mailing address:
  • Phone: 714-547-0969
  • Fax: 714-547-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA25829
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA36661
License Number StateCA

VIII. Authorized Official

Name: KRISHAN KHURANA
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 714-547-0969