Provider Demographics
NPI:1568452464
Name:MOHAN, DHRAMINDER (MD)
Entity Type:Individual
Prefix:
First Name:DHRAMINDER
Middle Name:
Last Name:MOHAN
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:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-3067
Mailing Address - Country:US
Mailing Address - Phone:530-751-4784
Mailing Address - Fax:530-751-4906
Practice Address - Street 1:726 FOUTH STREET
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5656
Practice Address - Country:US
Practice Address - Phone:530-749-4300
Practice Address - Fax:623-931-0088
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30571207L00000X
CAC55498207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ708729OtherAHCCCS
AZAZ0737950OtherBLUE CROSS
CAP01678089Medicare PIN
76242Medicare ID - Type Unspecified
AZ708729OtherAHCCCS
CACA175261Medicare PIN