Provider Demographics
NPI:1407827769
Name:NAIR, MOHAN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAN
Middle Name:
Last Name:NAIR
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 1:133 THE PROMENADE N STE 108
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4728
Mailing Address - Country:US
Mailing Address - Phone:562-495-3937
Mailing Address - Fax:562-206-0371
Practice Address - Street 1:133 THE PROMENADE N STE 108
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4728
Practice Address - Country:US
Practice Address - Phone:562-495-3937
Practice Address - Fax:562-206-0371
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA342492084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A34249Medicare ID - Type UnspecifiedMEDICARE