Provider Demographics
NPI:1356374094
Name:MOHINDROO, KRISHAN KUMAR JR (MD)
Entity type:Individual
Prefix:
First Name:KRISHAN
Middle Name:KUMAR
Last Name:MOHINDROO
Suffix:JR
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5717 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-1634
Practice Address - Country:US
Practice Address - Phone:704-563-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2550Medicaid
NC1356374094Medicaid
NC5905042Medicaid
NC2058522NMedicare PIN
NC2058522PMedicare PIN
NC2058522TMedicare PIN
NC2058522FMedicare PIN
SCNC2550Medicaid
NC1356374094Medicaid
NC2058522KMedicare PIN
NC2058522QMedicare PIN
NC2058522RMedicare PIN
NCNC5876BMedicare PIN
NC2058522CMedicare PIN
NC2058522SMedicare PIN
NCNC5876AMedicare PIN
NC5905042Medicaid
NCNC5876CMedicare PIN
NC2058522EMedicare PIN
NC2058522DMedicare PIN