Provider Demographics
NPI:1245314624
Name:JOHL, SUMIT (MD)
Entity type:Individual
Prefix:MRS
First Name:SUMIT
Middle Name:
Last Name:JOHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 YUBA ST RM 144
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-4838
Mailing Address - Country:US
Mailing Address - Phone:530-749-3242
Mailing Address - Fax:530-749-3248
Practice Address - Street 1:1275 THARP RD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2645
Practice Address - Country:US
Practice Address - Phone:530-749-3242
Practice Address - Fax:530-749-3248
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45643208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A456431Medicaid
CAA45643OtherCA
CAA5960926Medicare UPIN