Provider Demographics
NPI:1912908369
Name:MOHYI, DARUSH LAWRENCE (MD)
Entity Type:Individual
Prefix:MR
First Name:DARUSH
Middle Name:LAWRENCE
Last Name:MOHYI
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 1:7724 FAY AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4309
Mailing Address - Country:US
Mailing Address - Phone:858-454-2700
Mailing Address - Fax:858-454-2782
Practice Address - Street 1:7724 FAY AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4309
Practice Address - Country:US
Practice Address - Phone:858-454-2700
Practice Address - Fax:858-454-2782
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-06-22
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
CAA055635207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A556350Medicaid
CAG27984Medicare UPIN
CAA55635Medicare ID - Type Unspecified