Provider Demographics
NPI:1568228807
Name:AMANDEEP KAUR JOHAL, M.D., INC, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AMANDEEP KAUR JOHAL, M.D., INC, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDEEP
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:JOHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-635-0841
Mailing Address - Street 1:2693 FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4524
Mailing Address - Country:US
Mailing Address - Phone:248-635-0841
Mailing Address - Fax:
Practice Address - Street 1:2693 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-4524
Practice Address - Country:US
Practice Address - Phone:248-635-0841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center