=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972740835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A. R. MOHAN, MD INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2009
-----------------------------------------------------
Last Update Date | 01/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1818 N ORANGE GROVE AVE STE 300
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-3028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-622-6050
-----------------------------------------------------
Fax | 909-620-4632
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1818 N ORANGE GROVE AVE STE 300
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-3028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-622-6050
-----------------------------------------------------
Fax | 909-620-4632
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | AYYAMPALAYAM RAJU MOHAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 909-622-6050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | A37819
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | A37819
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------