1285895896 NPI number — MOHAN DIALYSIS CENTER OF COVINA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285895896 NPI number — MOHAN DIALYSIS CENTER OF COVINA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAN DIALYSIS CENTER OF COVINA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOHAN DIALYSIS CENTER OF GLENDORA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285895896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
638 S GLENDORA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDORA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91740-4483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-914-5553
Provider Business Mailing Address Fax Number:
626-914-5602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
638 S GLENDORA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91740-4483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-914-5553
Provider Business Practice Location Address Fax Number:
626-914-5602
Provider Enumeration Date:
06/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MOHAN
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
626-914-5553

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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