Provider Demographics
NPI:1174931869
Name:KATHRYN JOHNSON
Entity type:Organization
Organization Name:KATHRYN JOHNSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-908-0809
Mailing Address - Street 1:10261 CAMINITO AGADIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1719
Mailing Address - Country:US
Mailing Address - Phone:205-908-0809
Mailing Address - Fax:
Practice Address - Street 1:9974 SCRIPPS RANCH BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1825
Practice Address - Country:US
Practice Address - Phone:858-939-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128684282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital