# MYDOCKJ

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407129646
- **Authorized official:** KIM D JOHNSON MD (PRESIDENT)
- **Authorized official phone:** (602) 390-1509

## Contact information

- **Practice address:** 8520 E SHEA BLVD, STE 105, SCOTTSDALE, AZ 85260-6677
- **Practice address phone:** (602) 390-1509
- **Mailing address:** 10105 E VIA LINDA, STE 103-364, SCOTTSDALE, AZ 85258-5311
- **Mailing address phone:** (602) 390-1509

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 19257 | AZ | Yes |

## Other

- **Enumeration date:** 02/20/2012
- **Last updated:** 02/20/2012