Healthcare Provider Details

I. General information

NPI: 1962267542
Provider Name (Legal Business Name): KARANDEEP SINGH JOHAL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N JACKSON AVE
SAN JOSE CA
95116-1603
US

IV. Provider business mailing address

77 N ALMADEN AVE APT 1403
SAN JOSE CA
95110-2791
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-5000
  • Fax:
Mailing address:
  • Phone: 559-355-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95028621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: