Healthcare Provider Details

I. General information

NPI: 1972740835
Provider Name (Legal Business Name): A. R. MOHAN, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N ORANGE GROVE AVE STE 300
POMONA CA
91767-3028
US

IV. Provider business mailing address

1818 N ORANGE GROVE AVE STE 300
POMONA CA
91767-3028
US

V. Phone/Fax

Practice location:
  • Phone: 909-622-6050
  • Fax: 909-620-4632
Mailing address:
  • Phone: 909-622-6050
  • Fax: 909-620-4632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA37819
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA37819
License Number StateCA

VIII. Authorized Official

Name: AYYAMPALAYAM RAJU MOHAN
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 909-622-6050