Healthcare Provider Details

I. General information

NPI: 1083295521
Provider Name (Legal Business Name): MOHIT JETHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 NORRIS CANYON RD STE 200
SAN RAMON CA
94583-5440
US

IV. Provider business mailing address

5801 NORRIS CANYON RD STE 200
SAN RAMON CA
94583-5440
US

V. Phone/Fax

Practice location:
  • Phone: 925-830-8823
  • Fax:
Mailing address:
  • Phone: 707-344-1046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA209229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: