Provider Demographics
NPI:1154631554
Name:SOHAN S MAHIL M.D. INC.
Entity Type:Organization
Organization Name:SOHAN S MAHIL M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAHIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-466-2235
Mailing Address - Street 1:2626 N CALIFORNIA ST STE M
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5500
Mailing Address - Country:US
Mailing Address - Phone:209-466-2235
Mailing Address - Fax:209-466-6953
Practice Address - Street 1:2626 N CALIFORNIA ST STE M
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5500
Practice Address - Country:US
Practice Address - Phone:209-466-2235
Practice Address - Fax:209-466-6953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37000207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88405Medicaid
CAA88405Medicare PIN