Provider Demographics
NPI:1093193161
Name:MOHAN, GIRISH CHINTAMANI (MD)
Entity Type:Individual
Prefix:DR
First Name:GIRISH
Middle Name:CHINTAMANI
Last Name:MOHAN
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 1:3772 KATELLA AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6428
Mailing Address - Country:US
Mailing Address - Phone:424-329-0700
Mailing Address - Fax:424-329-0004
Practice Address - Street 1:3772 KATELLA AVE STE 206
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6428
Practice Address - Country:US
Practice Address - Phone:424-329-0700
Practice Address - Fax:424-329-0004
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT62550207N00000X, 207ND0101X, 207NS0135X
CAA170186207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology