Provider Demographics
NPI:1942491493
Name:SOHAL, MOHINDER SINGH (MD)
Entity Type:Individual
Prefix:
First Name:MOHINDER
Middle Name:SINGH
Last Name:SOHAL
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 1:2105 BEVERLY BLVD
Mailing Address - Street 2:SUITE 227
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2216
Mailing Address - Country:US
Mailing Address - Phone:213-484-8186
Mailing Address - Fax:213-484-0780
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:SUITE 227
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2216
Practice Address - Country:US
Practice Address - Phone:213-484-8186
Practice Address - Fax:213-484-0780
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29664207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA296640Medicaid
CAA87261Medicare UPIN
CAOOA296640Medicaid