Healthcare Provider Details

I. General information

NPI: 1447464458
Provider Name (Legal Business Name): SKANTHA KRUPA MANJUNATH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 KINGWOOD MEDICAL DR STE 100
KINGWOOD TX
77339-6408
US

IV. Provider business mailing address

451 KINGWOOD MEDICAL DR STE 100
KINGWOOD TX
77339-6408
US

V. Phone/Fax

Practice location:
  • Phone: 281-318-2043
  • Fax: 281-360-6306
Mailing address:
  • Phone: 281-318-2043
  • Fax: 281-360-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberS2635
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberS2635
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: