Basic Information
| Provider Information | |||||||||
| NPI: | 1790739720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOHAN | ||||||||
| FirstName: | KINILA | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 S COASTAL HWY | ||||||||
| Address2: | |||||||||
| City: | BETHANY BEACH | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199309203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025371100 | ||||||||
| FaxNumber: | 3025370921 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 ROSE ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592571000 | ||||||||
| FaxNumber: | 8592573347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C1-0005395 | DE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 49334 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.