Basic Information
| Provider Information | |||||||||
| NPI: | 1346522463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHN | ||||||||
| FirstName: | MOHAN | ||||||||
| MiddleName: | MATHEW | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.B.B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11175 CAMPUS ST STE 21121 | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923501700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095584354 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1405 CLIFTON RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047854249 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2011 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | A138617 | CA | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208G00000X | 89257 | GA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.