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General NPI Number Information
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NPI Number | 1104311596
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Entity Type | Individual
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Provider Name | VIJAY BALAKRISHNAN MD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 655 EUCLID AVE STE 304
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2974
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Country | US
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Telephone | 619-267-8303
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Fax |
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Provider Business Mailing Address
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Address Line | 510 20TH ST S STE 858
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City | BIRMINGHAM
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State | AL
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Zip | 35233-2028
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | LL52671
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 9971137
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 9971137
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License Number State | ID
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