Provider Demographics
NPI:1710991112
Name:MOHAN, KUMAR RAM (MD)
Entity Type:Individual
Prefix:
First Name:KUMAR
Middle Name:RAM
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 1:110 N VALERIA ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2168
Mailing Address - Country:US
Mailing Address - Phone:559-485-6750
Mailing Address - Fax:559-485-6221
Practice Address - Street 1:110 N VALERIA ST
Practice Address - Street 2:SUITE 503
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2168
Practice Address - Country:US
Practice Address - Phone:559-485-6750
Practice Address - Fax:559-485-6221
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30132207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4096616Medicaid
CA4096616Medicaid
D37938Medicare UPIN