Provider Demographics
NPI:1255335659
Name:MAHON, DONALD (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:MAHON
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 1:1140 W LA VETA AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4226
Mailing Address - Country:US
Mailing Address - Phone:714-543-5555
Mailing Address - Fax:714-836-2427
Practice Address - Street 1:1140 W LA VETA AVE STE 430
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4226
Practice Address - Country:US
Practice Address - Phone:714-543-5555
Practice Address - Fax:714-836-2427
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41581174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060062841OtherRAILROAD MEDICARE
CADB3373OtherRAILROAD MEDICARE
CAW13988OtherMEDICARE PTAN
CAW13988AOtherMEDICARE PTAN
CAE48110Medicare UPIN
CAHW13988Medicare PIN
CAHW13988BMedicare PIN
CAHW13988AMedicare PIN
CAWC41581MMedicare PIN