MEDICARE: GIRISH MOHAN MD INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1003520602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIRISH MOHAN MD INC.

Provider Business Mailing Address
First Line	:	325 N MAPLE DR UNIT 17773
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90209-5866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4653
Country	:	US
Telephone Number	:	310-873-3312
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GIRISH MOHAN
Credential	:
Telephone Number	:	310-873-3312

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2023

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