Healthcare Provider Details

I. General information

NPI: 1790428845
Provider Name (Legal Business Name): GURKARAN JOHAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 MAIN ST
BUFFALO NY
14203-1121
US

IV. Provider business mailing address

955 MAIN ST
BUFFALO NY
14203-1121
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-2802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number344194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: