MEDICARE: KRISHNA J 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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1043818388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISHNA J MOHAN MD INC

Provider Business Mailing Address
First Line	:	171 WEST COTTAGE ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2007
Country	:	US
Telephone Number	:	626-331-0175
Fax Number	:	626-967-3849

Provider Business Practice Location Address
First Line	:	171 WEST COTTAGE ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2007
Country	:	US
Telephone Number	:	626-331-0175
Fax Number	:	626-967-3849

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KRISHNA J MOHAN
Credential	:	MD
Telephone Number	:	626-331-0175

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	10/09/2020

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