Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | A94700 | CA |
Y | 208000000X | Pediatrician | A94700 | CA |
NPI | 1528036852 |
---|---|
Provider Name | Smita Krishna Mohan |
First Address | Hayward, CA 94545-4203 |
Second Address | Hayward, CA 94545-4203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2006 |
Last Update Date | 19/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200065050A | (05) | OK |