Basic Information
| Provider Information | |||||||||
| NPI: | 1942793054 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHAL | ||||||||
| FirstName: | KIRAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 MARYLAND RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154814143 | ||||||||
| FaxNumber: | 2154816790 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 HIGHLAND AVE STE 308 | ||||||||
| Address2: | |||||||||
| City: | ABINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190013724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154815450 | ||||||||
| FaxNumber: | 2154815435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2018 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | OS020733 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | OT018291 | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.