MEDICARE: SANTOSH KUMAR MOHANTY M.D.

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	174400000X	Specialist	C37357	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	C37357	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1508822990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTOSH KUMAR MOHANTY M.D.

Provider Business Mailing Address
First Line	:	17822 BEACH BLVD
Second Line	:	SUITE 263
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-7101
Country	:	US
Telephone Number	:	714-847-8113
Fax Number	:	714-842-2497

Provider Business Practice Location Address
First Line	:	17822 BEACH BLVD
Second Line	:	SUITE 263
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-7101
Country	:	US
Telephone Number	:	714-847-8113
Fax Number	:	714-842-2497

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/08/2007

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Directions to “ SANTOSH KUMAR MOHANTY M.D.” Practice Location

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