Healthcare Provider Details

I. General information

NPI: 1992361356
Provider Name (Legal Business Name): SUBHA MOHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2019
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 FOREST AVE
SAN JOSE CA
95128-4817
US

IV. Provider business mailing address

1333 MERIDIAN AVE
SAN JOSE CA
95125-5212
US

V. Phone/Fax

Practice location:
  • Phone: 408-947-2929
  • Fax: 408-283-7720
Mailing address:
  • Phone: 408-445-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA178969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: