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General NPI Number Information
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NPI Number | 1477645786
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Entity Type | Individual
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Provider Name | KRISHNA JATAVALLABHULA MOHAN MD
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 158 W COLLEGE ST
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City | COVINA
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State | CA
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Zip | 91723
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Country | US
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Telephone | 626-331-0175
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Fax | 626-967-3849
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Provider Business Mailing Address
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Address Line | 158 W COLLEGE ST
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City | COVINA
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State | CA
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Zip | 91723
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Country | US
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Telephone | 626-331-0175
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Fax | 626-967-3849
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A34175
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A34175
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License Number State | CA
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