=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710991112
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KUMAR RAM MOHAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 N VALERIA ST SUITE 503
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93701-2168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-485-6750
-----------------------------------------------------
Fax | 559-485-6221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 N VALERIA ST SUITE 503
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93701-2168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-485-6750
-----------------------------------------------------
Fax | 559-485-6221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | A30132
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------