Healthcare Provider Details

I. General information

NPI: 1245764349
Provider Name (Legal Business Name): JASMYN KAUR JOHAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR RM G333
STANFORD CA
94305-2200
US

IV. Provider business mailing address

PO BOX 147
SUNOL CA
94586-0147
US

V. Phone/Fax

Practice location:
  • Phone: 650-498-7570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA157037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: