Provider Demographics
NPI:1275530529
Name:JOHAL, DHARAMPAL S (MD)
Entity Type:Individual
Prefix:
First Name:DHARAMPAL
Middle Name:S
Last Name:JOHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26297
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6297
Mailing Address - Country:US
Mailing Address - Phone:559-431-2525
Mailing Address - Fax:559-446-1500
Practice Address - Street 1:7011 N HOWARD ST
Practice Address - Street 2:STE 201
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2955
Practice Address - Country:US
Practice Address - Phone:559-431-2525
Practice Address - Fax:559-446-1500
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA560180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A560180Medicaid
CAAY404ZOtherMEDICARE PTAN
CA00A560180Medicaid