Provider Demographics
NPI:1558522151
Name:MOHAN DIALYSIS CENTER OF COVINA, INC
Entity Type:Organization
Organization Name:MOHAN DIALYSIS CENTER OF COVINA, INC
Other - Org Name:MOHAN DIALYSIS CENTER OF INDUSTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-914-5553
Mailing Address - Street 1:638 S GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4483
Mailing Address - Country:US
Mailing Address - Phone:626-914-5553
Mailing Address - Fax:626-914-5602
Practice Address - Street 1:15757 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91744-3900
Practice Address - Country:US
Practice Address - Phone:626-333-3801
Practice Address - Fax:626-336-1303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOHAN DIALYSIS CENTER OF COVINA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-17
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA052854Medicare Oscar/Certification