Provider Demographics
NPI:1427378363
Name:BARZAN MOHEDIN, MD, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BARZAN MOHEDIN, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHEDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-668-9596
Mailing Address - Street 1:8860 CENTER DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3068
Mailing Address - Country:US
Mailing Address - Phone:619-668-9596
Mailing Address - Fax:619-667-0267
Practice Address - Street 1:8860 CENTER DR
Practice Address - Street 2:SUITE 310
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3068
Practice Address - Country:US
Practice Address - Phone:619-668-9596
Practice Address - Fax:619-667-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50839207R00000X, 207RC0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A508390Medicaid
F97557Medicare UPIN
A50839Medicare PIN