Healthcare Provider Details

I. General information

NPI: 1093767105
Provider Name (Legal Business Name): ANIL MOHIN MD, FACC A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 SOUTH ALVARADO STREET
LOS ANGELES CA
90057-4021
US

IV. Provider business mailing address

745 SOUTH ALVARADO STREET
LOS ANGELES CA
90057-4021
US

V. Phone/Fax

Practice location:
  • Phone: 213-252-2225
  • Fax: 213-252-2244
Mailing address:
  • Phone: 213-252-2225
  • Fax: 213-252-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA40506
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG10040
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number00A444940
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG45111
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG81239
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA66159
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4013
License Number StateCA

VIII. Authorized Official

Name: DR. ANIL MOHIN
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 213-252-2225