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General NPI Number Information
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NPI Number | 1346522463
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Entity Type | Individual
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Provider Name | MOHAN MATHEW JOHN M.B.B.S.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 1405 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-1700
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Country | US
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Telephone | 404-785-4249
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Fax |
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Provider Business Mailing Address
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Address Line | 11175 CAMPUS ST STE 21121
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City | LOMA LINDA
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State | CA
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Zip | 92350-1700
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Country | US
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Telephone | 909-558-4354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | A138617
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 89257
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License Number State | GA
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