Healthcare Provider Details

I. General information

NPI: 1215466131
Provider Name (Legal Business Name): OVNINDER SINGH JOHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 HOSPITAL PKWY BLDG A
SAN JOSE CA
95119-1103
US

IV. Provider business mailing address

280 HOSPITAL PKWY BLDG A
SAN JOSE CA
95119-1103
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-7553
  • Fax:
Mailing address:
  • Phone: 408-972-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number286133
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberU9278
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA201451
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA201451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: