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General NPI Number Information
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NPI Number | 1558522151
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Entity Type | Organization
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Legal Business Name | MOHAN DIALYSIS CENTER OF COVINA, INC
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 15757 E VALLEY BLVD
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91744-3900
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Country | US
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Telephone | 626-333-3801
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Fax | 626-336-1303
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Provider Business Mailing Address
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Address Line | 638 S GLENDORA AVE
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City | GLENDORA
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State | CA
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Zip | 91740-4483
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Country | US
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Telephone | 626-914-5553
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Fax | 626-914-5602
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. ANNA J MOHAN
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Credential |
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Telephone | 626-914-5553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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