Provider Demographics
NPI:1831376698
Name:ANIL MOHIN M.D., F.A.C.C. II, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:ANIL MOHIN M.D., F.A.C.C. II, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-661-5371
Mailing Address - Street 1:1321 N VERMONT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6307
Mailing Address - Country:US
Mailing Address - Phone:323-661-5371
Mailing Address - Fax:323-661-4101
Practice Address - Street 1:1321 N VERMONT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6307
Practice Address - Country:US
Practice Address - Phone:323-661-5371
Practice Address - Fax:323-661-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40506174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F51466Medicare UPIN
F02715Medicare UPIN
G80640Medicare UPIN