Healthcare Provider Details

I. General information

NPI: 1518343649
Provider Name (Legal Business Name): KARENJIT JOHAL R.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 17TH ST
MODESTO CA
95354-1209
US

IV. Provider business mailing address

141 BLUE SPRUCE LN
UNION CITY CA
94587-8035
US

V. Phone/Fax

Practice location:
  • Phone: 209-248-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86029687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: