KRISHNAMOORTHI M.D. INC. NPI 1528119435

NPI Information

NPI: 1528119435
Provider Name: KRISHNAMOORTHI M.D. INC.
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 05D0989666

Address:
2222 E ORANGEBURG AVE
SUITE A2
MODESTO, CA
ZIP 95355
Phone: (209) 622-0877
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KRISHNAMOORTHI M.D. INC. is a primary care clinic center in Modesto, CA. KRISHNAMOORTHI M.D. INC. NPI is 1528119435. The provider is registered as an organization entity type.

The provider's business location address is:

2222 E ORANGEBURG AVE
SUITE A2
MODESTO, CA
ZIP 95355-399
Phone: (209) 622-0877
Fax: (209) 622-0956

The provider's authorized official is Krishnamoorthi Krishnamoorthi .
The authorized official title is Ceo and has the following contact phone number (209) 622-0877.

The CLIA number assigned to this NPI record is 05D0989666 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/16/2007 and was last updated on 11/16/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	ZZZ04426Z	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	MCR GROUP ID
2	PA20513	OTHER	CALIFORNIA	CO676Z
3	00A708970	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	K. KRISHNAMOORTHI, MD ID
4	GR0104660	MEDICAID	CALIFORNIA
5	00A765620	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	SOMA KRISHNAMOORTHI MD ID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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