Provider Demographics
NPI:1043818388
Name:KRISHNA J MOHAN MD INC
Entity Type:Organization
Organization Name:KRISHNA J MOHAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-331-0175
Mailing Address - Street 1:171 WEST COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2007
Mailing Address - Country:US
Mailing Address - Phone:626-331-0175
Mailing Address - Fax:626-967-3849
Practice Address - Street 1:171 WEST COTTAGE ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2007
Practice Address - Country:US
Practice Address - Phone:626-331-0175
Practice Address - Fax:626-967-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty