Provider Demographics
NPI:1245492677
Name:JOHL, JASKARN S (DO)
Entity type:Individual
Prefix:
First Name:JASKARN
Middle Name:S
Last Name:JOHL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10837 LAUREL ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7643
Mailing Address - Country:US
Mailing Address - Phone:909-259-0903
Mailing Address - Fax:909-466-7607
Practice Address - Street 1:10837 LAUREL ST
Practice Address - Street 2:SUITE 103
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7643
Practice Address - Country:US
Practice Address - Phone:909-259-0903
Practice Address - Fax:909-466-7607
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A11065207W00000X
CA11065207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA219752Medicare UPIN