Provider Demographics
NPI:1013126622
Name:JHAWAR, VIBHA
Entity Type:Individual
Prefix:
First Name:VIBHA
Middle Name:
Last Name:JHAWAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6522 PARK RIVIERA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-1022
Mailing Address - Country:US
Mailing Address - Phone:916-730-2888
Mailing Address - Fax:
Practice Address - Street 1:8233 E STOCKTON BLVD STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-8203
Practice Address - Country:US
Practice Address - Phone:167-375-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist