Healthcare Provider Details

I. General information

NPI: 1407852858
Provider Name (Legal Business Name): JEWEL JOHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 LENNON LN
WALNUT CREEK CA
94598-2443
US

IV. Provider business mailing address

575 LENNON LN
WALNUT CREEK CA
94598-2443
US

V. Phone/Fax

Practice location:
  • Phone: 925-433-8786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA69437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: