Provider Demographics
NPI:1265466445
Name:MOHANS PC
Entity Type:Organization
Organization Name:MOHANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DHRAMINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-931-1225
Mailing Address - Street 1:P O BOX 81349
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-1349
Mailing Address - Country:US
Mailing Address - Phone:623-931-1225
Mailing Address - Fax:623-931-0088
Practice Address - Street 1:19829 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:623-931-1225
Practice Address - Fax:623-931-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30571174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0737950OtherBLUE CROSS BLUE SHIELD
AZP00059001OtherRAILROAD MEDICARE
AZ708729Medicaid
AZAW4710OtherHEALTHNET
AZH64607Medicare UPIN
AZ708729Medicaid