# DHP OF MISSION MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033474325
- **Authorized official:** DR. SUJAL MANDAVIA M.D. (PRESIDENT)
- **Authorized official phone:** (865) 693-1000

## Contact information

- **Practice address:** 27700 MEDICAL CENTER RD, MISSION VIEJO, CA 92691-6426
- **Practice address phone:** (949) 364-1400
- **Mailing address:** 265 BROOKVIEW CENTRE WAY, SUITE 400, KNOXVILLE, TN 37919-4052
- **Mailing address phone:** (865) 693-1000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208M00000X | Hospitalist Physician | — | NULL | — |
| 208M00000X | Hospitalist Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363AS0400X | Surgical Physician Assistant | — | NULL | — |
| 363AS0400X | Surgical Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 07/12/2012
- **Last updated:** 07/20/2012