Active NPI
Rajkumar Krishnan
- Speech-Language Pathologist
- Fullerton, CA
National Provider Identifier
1073901393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP 17426
- Practice address
- 3200 E Palm Dr
Apt 322
Fullerton, CA 92831-1757 - Phone
- (909) 749-9541
- NPI assigned
- Jan 8, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP 17426 | CA | Primary |
Addresses
Primary practice location
3200 E Palm Dr
Apt 322
Fullerton, CA 92831-1757
Mailing address
3200 E Palm Dr
Apt 322
Fullerton, CA 92831-1757
Phone (909) 749-9541
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP 17426 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420675200000",
"number": "1073901393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 E PALM DR",
"address_2": "APT 322",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928311757",
"telephone_number": "909-749-9541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 E PALM DR",
"address_2": "APT 322",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928311757",
"telephone_number": "909-749-9541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRISHNAN",
"first_name": "RAJKUMAR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-08",
"last_updated": "2015-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "SP 17426",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.