Provider Demographics
NPI:1316115215
Name:SHANTI MOHAN MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:SHANTI MOHAN MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DINESHCHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-946-1344
Mailing Address - Street 1:18092 WIKA RD STE 220
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2132
Mailing Address - Country:US
Mailing Address - Phone:760-946-1344
Mailing Address - Fax:760-242-0124
Practice Address - Street 1:18092 WIKA RD STE 220
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2132
Practice Address - Country:US
Practice Address - Phone:760-242-9828
Practice Address - Fax:760-242-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty