Provider Demographics
NPI:1891807863
Name:KRISHNANANTHAN, RUBEN (MD)
Entity type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:KRISHNANANTHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4746
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000451872085R0202X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0356361OtherL&I-RADIA-REST OF WA
WA0356365OtherL&I-SWEDISH RADIA
WA0356366OtherL&I-EVERGREEN RADIA
WA1021587Medicaid
WA0356365OtherL&I-SWEDISH RADIA
WAG8950550Medicare PIN
WAG8950542Medicare PIN
WAP01623724Medicare PIN
WA0356361OtherL&I-RADIA-REST OF WA
WA1021587Medicaid
WAG8950547Medicare PIN
ID20009879Medicare PIN