Provider Demographics
NPI:1518084763
Name:JOHNSON, JOY MASON (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:MASON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOY
Other - Middle Name:MASON
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1603 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3908
Mailing Address - Country:US
Mailing Address - Phone:714-542-3597
Mailing Address - Fax:714-542-1876
Practice Address - Street 1:1603 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3908
Practice Address - Country:US
Practice Address - Phone:714-542-3597
Practice Address - Fax:714-542-1876
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG188242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology