Provider Demographics
NPI:1437352556
Name:MOHAN, UTHARA RAJU (MD)
Entity type:Individual
Prefix:
First Name:UTHARA
Middle Name:RAJU
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 DOVER DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5735
Mailing Address - Country:US
Mailing Address - Phone:949-646-1495
Mailing Address - Fax:949-646-2596
Practice Address - Street 1:601 DOVER DR
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5735
Practice Address - Country:US
Practice Address - Phone:949-646-1495
Practice Address - Fax:949-646-2596
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA99639208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics