Provider Demographics
NPI:1093717886
Name:MOHUCHY, MYKOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MYKOLA
Middle Name:
Last Name:MOHUCHY
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 1:162 VIA MONTE DORO
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6440
Mailing Address - Country:US
Mailing Address - Phone:424-247-9607
Mailing Address - Fax:424-247-9607
Practice Address - Street 1:162 VIA MONTE DORO
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6440
Practice Address - Country:US
Practice Address - Phone:424-247-9607
Practice Address - Fax:424-247-9607
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2324252085R0202X
MDD00733522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology