Provider Demographics
NPI:1699710533
Name:KRISHNAKUMAR, TAMISELVI (MD)
Entity type:Individual
Prefix:
First Name:TAMISELVI
Middle Name:
Last Name:KRISHNAKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9375 SAN FERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-1418
Mailing Address - Country:US
Mailing Address - Phone:818-768-3000
Mailing Address - Fax:818-504-4690
Practice Address - Street 1:9375 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-1418
Practice Address - Country:US
Practice Address - Phone:818-768-3000
Practice Address - Fax:818-504-4690
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48922208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489220Medicaid
CAE71028Medicare UPIN
CA00A489220Medicaid