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General NPI Number Information
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NPI Number | 1043526882
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Entity Type | Organization
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Legal Business Name | S. KRISHNAN MD INC
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 1031 E LATHAM AVE #3
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City | HEMET
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State | CA
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Zip | 92543-4425
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Country | US
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Telephone | 951-766-7030
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Fax | 951-766-5800
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Provider Business Mailing Address
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Address Line | 1031 E LATHAM AVE #3
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City | HEMET
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State | CA
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Zip | 92543-4425
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Country | US
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Telephone | 951-766-7030
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Fax | 951-766-5800
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUBBARAYAN KRISHNAN
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Credential | M.D.
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Telephone | 951-766-7030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A054481
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License Number State | CA
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