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Organization
KARL JOHSENS MD & DRUSILLA LDH LEE MD INC
Active
Organization
KARL JOHSENS MD & DRUSILLA LDH LEE MD INC
Active
Other names
Cedar Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KARL KNUDSEN JOHSEN MD (PHYSICIAN PRESIDENT)
(831) 425-1279
Entity
Organization
Contact information
Practice address
1595 SOQUEL DR STE 340, SANTA CRUZ, CA 95065-1722
(831) 425-1279
(831) 425-3500
Mailing address
1595 SOQUEL DR STE 340, SANTA CRUZ, CA 95065-1722
(831) 425-1279
(831) 425-3500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G084030
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G840300
BLUE SHIELD
—
05
—
00G840300
—
CA
01
—
110208332
MEDICARE RAILROAD
—
01
—
610730500
US DEPT OF LABOR OFFICE O
—
01
—
CH1649
GROUP MEDICARE RAILROAD
—
01
—
G054030
BLUE CROSS
CA
05
—
GR0090740
—
CA
01
—
ZZZ62382Z
GROUP BLUE SHIELD CEDAR M
—
Enumeration date
08/04/2006
Last updated
07/11/2019
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