Kanan Modi, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A38793 Issued in CA

Practice address

1305 W Arrow Hwy Ste 104
San Dimas, CA 91773-2337

Phone

(909) 967-7826

Fax

(909) 394-9461

NPI assigned

Aug 30, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emanate Health Medical Care Foundation

  • Multi-Specialty Clinic/Center
  • West Covina, CA
  • NPI 1467195073
  Medicare reassignment NPD
• Alta Newport Hospital, LLC

  • General Acute Care Hospital
  • Tustin, CA
  • NPI 1043632938
  NPD (past)
• Emanate Health Foothill Presbyterian Hospital

  • General Acute Care Hospital
  • Glendora, CA
  • NPI 1992733513
  NPD (past)
• Emanate Health Medical Center

  • General Acute Care Hospital
  • West Covina, CA
  • NPI 1063441293
  NPD (past)
• Emanate Health Medical Center

  • General Acute Care Hospital
  • Covina, CA
  • NPI 1982629440
  NPD (past)
• Emanate Health Medical Group

  • General Practice Physician
  • Covina, CA
  • NPI 1881054997
  NPD (past)
• Pomona Valley Hospital Medical Center

  • General Acute Care Hospital
  • Pomona, CA
  • NPI 1518067586
  NPD (past)
• San Dimas Community Hospital, Inc.

  • Skilled Nursing Facility
  • San Dimas, CA
  • NPI 1568487619
  NPD (past)
• St. Joseph Health Northern California, LLC

  • Rehabilitation Hospital Unit
  • Napa, CA
  • NPI 1609947282
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1881704898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 W ARROW HWY",
            "address_2": "104",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732336",
            "telephone_number": "909-394-9004",
            "fax_number": "909-394-9461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 W ARROW HWY STE 104",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732337",
            "telephone_number": "909-967-7826",
            "fax_number": "909-394-9461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15888 Main St Ste 112B",
            "address_purpose": "LOCATION",
            "city": "Hesperia",
            "state": "CA",
            "postal_code": "923453467",
            "country_code": "US",
            "telephone_number": "760-948-2242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MODI",
        "first_name": "KANAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A38793",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A38793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A387930",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "A38793",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mind and Heart Family Counseling
• Megan Maria Minnick, LPCC
• Timothy Minnihan, RN
• Mira Integrated Holdings Inc
• Angeline Mitchell
• Roy H Moffatt, M.D.
• Jasmine B Moghadam, NURSE PRACTITIONER
• Mojtaba Moghadam I, M.D.
• Mohammed Khalife, M.D., Corporation
• Mohsen I Ali M D Inc

• Pediatrics Physician in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.

Verify at the official NPI Registry.