MEDICARE: DR. JOHN MOGANNAM

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	20A22102	CA
2	207R00000X	Internal Medicine Physician	20A22102	CA
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1205561859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MOGANNAM

Provider Business Mailing Address
First Line	:	378 EMBARCADERO W UNIT 419
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-4534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 BROADWAY STE 2700
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-1536
Country	:	US
Telephone Number	:	916-734-9913
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	03/12/2026

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Directions to “ DR. JOHN MOGANNAM ” Practice Location

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