Basic Information
| Provider Information | |||||||||
| NPI: | 1497940712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRISHNAN | ||||||||
| FirstName: | PRIYANKA | ||||||||
| MiddleName: | BHAT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23141 MOULTON PARKWAY STE 102 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499169100 | ||||||||
| FaxNumber: | 9499160091 | ||||||||
| Practice Location | |||||||||
| Address1: | 23141 MOULTON PARKWAY STE 102 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499169100 | ||||||||
| FaxNumber: | 9499160091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 2011020924 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | A130175 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 9024702 | 01 | FL | AETNA | OTHER | 1497940712 | 05 | MO | MEDICAID | P01000140 | 01 | MO | RAIL ROAD MEDICARE | OTHER | 008787800 | 05 | FL | MEDICAID | 14MJ4 | 01 | FL | FLORIDA BLUE | OTHER | 0821154 | 01 | FL | CIGNA | OTHER | P01164119 | 01 | FL | RR MEDICARE GROUP DT5990 | OTHER |