Provider Demographics
NPI:1790977874
Name:JOHAL, GURPREET (DO)
Entity Type:Individual
Prefix:
First Name:GURPREET
Middle Name:
Last Name:JOHAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 WILBUR AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1309
Mailing Address - Country:US
Mailing Address - Phone:916-966-6544
Mailing Address - Fax:916-966-6547
Practice Address - Street 1:6501 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0306
Practice Address - Country:US
Practice Address - Phone:916-537-5000
Practice Address - Fax:916-851-2884
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9992207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG835XMedicare PIN
CACG835YMedicare PIN
CAP00782707Medicare PIN
CARES000Medicare UPIN
CAP00850805Medicare PIN
CACG835WMedicare PIN
CACG835ZMedicare PIN