Basic Information
| Provider Information | |||||||||
| NPI: | 1265466445 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOHANS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 81349 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850691349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239311225 | ||||||||
| FaxNumber: | 6239310088 | ||||||||
| Practice Location | |||||||||
| Address1: | 19829 N 27TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239311225 | ||||||||
| FaxNumber: | 6239310088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 06/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | MOHAN | ||||||||
| AuthorizedOfficialFirstName: | DHRAMINDER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 6239311225 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 30571 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0737950 | 01 | AZ | BLUE CROSS BLUE SHIELD | OTHER | P00059001 | 01 | AZ | RAILROAD MEDICARE | OTHER | 708729 | 05 | AZ | MEDICAID | AW4710 | 01 | AZ | HEALTHNET | OTHER |