Healthcare Provider Details

I. General information

NPI: 1952102683
Provider Name (Legal Business Name): KAJOL JEWAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 TOPANGA CANYON BLVD
CANOGA PARK CA
91303-2609
US

IV. Provider business mailing address

14466 SHAWNEE ST
MOORPARK CA
93021-3571
US

V. Phone/Fax

Practice location:
  • Phone: 818-348-7700
  • Fax:
Mailing address:
  • Phone: 805-259-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: