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1558522151 NPI number — MOHAN DIALYSIS CENTER OF COVINA, INC

NPI Number: 1558522151
Health Care Provider/Practitioner: MOHAN DIALYSIS CENTER OF COVINA, INC

Information about “1558522151” NPI (MOHAN DIALYSIS CENTER OF COVINA, INC) exists in 1558522151 in HTML format HTML  |  1558522151 in plain Text format TXT  |  1558522151 in PDF (Portable Document Format) PDF  |  1558522151 in an XML format XML  formats.

NPI Number : 1558522151 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558522151",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "MOHAN DIALYSIS CENTER OF COVINA, INC",
    "ParentOrgTIN": null,
    "OrgName": "MOHAN DIALYSIS CENTER OF COVINA, INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "638 S GLENDORA AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GLENDORA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91740-4483",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "626-914-5553",
    "MailingAddressFaxNumber": "626-914-5602",
    "FirstLinePracticeLocationAddress": "15757 E VALLEY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CITY OF INDUSTRY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91744-3900",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "626-333-3801",
    "PracticeLocationAddressFaxNumber": "626-336-1303",
    "EnumerationDate": "06/17/2008",
    "LastUpdateDate": "03/18/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MOHAN",
    "AuthorizedOfficialFirstName": "ANNA",
    "AuthorizedOfficialMiddleName": "J",
    "AuthorizedOfficialTitle": "BUSINESS MANAGER",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "626-914-5553",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261Q00000X",
          "TaxonomyName": "Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QE0700X",
          "TaxonomyName": "End-Stage Renal Disease (ESRD) Treatment Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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