Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301107494 | MI |
Y | 207Q00000X | Family Doctor | A164441 | CA |
NPI | 1003297839 |
---|---|
Provider Name | Dr. Vijay Krishna |
First Address | Hanford, CA 93230-7491 |
Second Address | Hanford, CA 93230-5965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2015 |
Last Update Date | 31/01/2022 |