Basic Information
| Provider Information | |||||||||
| NPI: | 1407086853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRISHNAN | ||||||||
| FirstName: | KARTIK | ||||||||
| MiddleName: | RAMA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 TREAT BLVD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945972168 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1220 ROSSMOOR PARKWAY | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945952501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259473312 | ||||||||
| FaxNumber: | 9259473396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2009 | ||||||||
| LastUpdateDate: | 11/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ML60096107 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A130827 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | ML60096107 | 01 | WA | PHYSICIAN AND SURGEON RESIDENCY LICENSE | OTHER |