Active NPI
Sugandha Mohan
- Dentist
- Phoenix, AZ
National Provider Identifier
1336520980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D009307
- Practice address
- 1820 N 75TH Ave
Phoenix, AZ 85035-4533 - Phone
- (623) 255-3607
- NPI assigned
- Jun 9, 2015
- Last updated
- Jul 17, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | D009307 | AZ | Primary |
Addresses
Primary practice location
1820 N 75TH Ave
Phoenix, AZ 85035-4533
Mailing address
4950 E Van Buren St Apt 328
Phoenix, AZ 85008-7050
Phone (646) 264-8736
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170306002398 | AZ | Order and Referring Only - Other (Non-Physician) | 4880978105 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D009307 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437091200000",
"number": "1336520980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4950 E VAN BUREN ST APT 328",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850087050",
"telephone_number": "646-264-8736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1820 N 75TH AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850354533",
"telephone_number": "623-255-3607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHAN",
"first_name": "SUGANDHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-09",
"last_updated": "2015-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D009307",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.