Healthcare Provider Details

I. General information

NPI: 1255128252
Provider Name (Legal Business Name): JKG NURSING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15722 VINCENNES ST
NORTH HILLS CA
91343-3166
US

IV. Provider business mailing address

25044 PEACHLAND AVE STE 110
NEWHALL CA
91321-5730
US

V. Phone/Fax

Practice location:
  • Phone: 209-849-6543
  • Fax:
Mailing address:
  • Phone: 818-636-6749
  • Fax: 818-356-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAGMOHAN GHOTRA
Title or Position: PRESIDENT & CEO
Credential: DNP
Phone: 209-849-6543