Healthcare Provider Details

I. General information

NPI: 1275470825
Provider Name (Legal Business Name): SUJAL POKHAREL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3699 HOLLY AVE
BALDWIN PARK CA
91706-5327
US

IV. Provider business mailing address

6755 EDINBORO ST
CHINO CA
91710-1310
US

V. Phone/Fax

Practice location:
  • Phone: 626-962-3311
  • Fax:
Mailing address:
  • Phone: 626-962-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number26774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: