Provider Demographics
NPI:1780781997
Name:KRISHNA J MOHAN M D INC
Entity type:Organization
Organization Name:KRISHNA J MOHAN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:JATAVALLABHULA
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-331-0175
Mailing Address - Street 1:171 W COTTAGE STREET
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723
Mailing Address - Country:US
Mailing Address - Phone:626-331-0175
Mailing Address - Fax:626-967-3849
Practice Address - Street 1:171 W COTTAGE DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2010
Practice Address - Country:US
Practice Address - Phone:626-331-0175
Practice Address - Fax:626-967-3849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRISHNA J MOHAN M D INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341750OtherMEDI-CAL
CAW15464Medicare PIN
CAW15464Medicare ID - Type Unspecified