MEDICARE: MOHAN DIALYSIS CENTER OF COVINA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	052854	CA
2	261Q00000X	Clinic/Center	552538	CA
3	261Q00000X	Clinic/Center	052726	CA
4	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841201738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHAN DIALYSIS CENTER OF COVINA, INC.

Provider Business Mailing Address
First Line	:	158 W COLLEGE ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2007
Country	:	US
Telephone Number	:	626-859-2522
Fax Number	:	626-331-0205

Provider Business Practice Location Address
First Line	:	158 W COLLEGE ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2007
Country	:	US
Telephone Number	:	626-859-2522
Fax Number	:	626-331-0205

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	DR. KRISHNA J MOHAN
Credential	:	M.D.
Telephone Number	:	626-859-2522

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	04/12/2023

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