Active NPI
Mohan Sundareson, M.D.,
- Pediatrics Physician
- San Mateo, CA
National Provider Identifier
1669820858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 40596
- Practice address
- 1638 South Grant St
San Mateo, CA 94402 - Phone
- (650) 571-6283
- NPI assigned
- May 27, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 40596 | CA | Primary |
Addresses
Primary practice location
1638 South Grant St
San Mateo, CA 94402
Mailing address
1638, South Grant Street
San Mateo, CA 94402
Phone (650) 571-6283
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40596 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464307200000",
"number": "1669820858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1638, SOUTH GRANT STREET",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "94402",
"telephone_number": "650-571-6283",
"fax_number": "650-571-6283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1638 SOUTH GRANT ST",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "94402",
"telephone_number": "650-571-6283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUNDARESON",
"first_name": "MOHAN",
"name_prefix": "Dr.",
"credential": "M.D.,",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-27",
"last_updated": "2016-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "40596",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.