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General NPI Number Information
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NPI Number | 1275515728
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Entity Type | Individual
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Provider Name | MADHAVAN KRISHNAN MD
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Gender | Male
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 08/12/2011
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Provider Practice Location Address
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Address Line | 27725 SANTA MARGARITA PKWY STE 101
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6704
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Country | US
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Telephone | 949-462-3999
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Fax | 949-462-3777
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Provider Business Mailing Address
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Address Line | 27758 SANTA MARGARITA PKWY #409
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6709
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Country | US
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Telephone | 949-583-9264
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Fax | 949-269-9139
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A87502
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License Number State | CA
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