Healthcare Provider Details

I. General information

NPI: 1922889294
Provider Name (Legal Business Name): MOCHI MEDICAL NJ P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 NATOMA ST
SAN FRANCISCO CA
94105-3746
US

IV. Provider business mailing address

161 NATOMA ST
SAN FRANCISCO CA
94105-3746
US

V. Phone/Fax

Practice location:
  • Phone: 952-250-8191
  • Fax:
Mailing address:
  • Phone: 952-250-8191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BENNETT WINTON
Title or Position: CHIEF OF STAFF
Credential:
Phone: 952-250-8191