Provider Demographics
NPI:1063616712
Name:SOHAL, JENNIFER KAUR RODRIGUEZ (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER KAUR
Middle Name:RODRIGUEZ
Last Name:SOHAL
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 1:2105 BEVERLY BLVD STE 227
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2282
Mailing Address - Country:US
Mailing Address - Phone:213-484-8431
Mailing Address - Fax:213-484-0780
Practice Address - Street 1:2105 BEVERLY BLVD STE 227
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2282
Practice Address - Country:US
Practice Address - Phone:213-484-8431
Practice Address - Fax:213-484-0780
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42445207XS0117X, 207X00000X
NY241425207X00000X
CAA109393207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00533174Medicare PIN