Provider Demographics
NPI:1437779543
Name:JOTHIKUMAR, KRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:
Last Name:JOTHIKUMAR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:SANJAI
Other - Middle Name:KRISHNA
Other - Last Name:JOTHIKUMAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4791 E PALM CANYON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-5232
Mailing Address - Country:US
Mailing Address - Phone:760-834-7930
Mailing Address - Fax:760-834-7931
Practice Address - Street 1:8820 WILSHIRE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2620
Practice Address - Country:US
Practice Address - Phone:310-423-4945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-18
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA187255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine