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NPI Code Detail

MEDICARE: GURPREET SINGH JOHAL M.D

MEDICARE: GURPREET SINGH JOHAL M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician008736GA
2390200000XStudent in an Organized Health Care Education/Training Program
3207RI0011XInterventional Cardiology PhysicianBC61197599WA

General Provider Information

NPI Number : 1568751154
Entity Type Code : Individual
Provider Name (Legal Business Name) : GURPREET SINGH JOHAL M.D
Provider Business Mailing Address
First Line : 3600 LIND AVE SW
Second Line : SUITE 100 ATTN CREDENTIALING
City : RENTON
State : WA
Zip : 98057-4970
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4011 TALBOT RD S STE 500
Second Line :
City : RENTON
State : WA
Zip : 98055-5782
Country : US
Telephone Number : 425-690-3482
Fax Number : 425-690-9082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2011
Last Update Date : 12/13/2021

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