Provider Demographics
NPI:1114678448
Name:KORPAL, JATINDER
Entity Type:Individual
Prefix:MR
First Name:JATINDER
Middle Name:
Last Name:KORPAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 YARROW PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1875
Mailing Address - Country:US
Mailing Address - Phone:510-234-8888
Mailing Address - Fax:
Practice Address - Street 1:1103 YARROW PL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1875
Practice Address - Country:US
Practice Address - Phone:510-234-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40032208344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi