Individual
KENNETH M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
901 4TH ST NW, WATERTOWN, SD 57201-1558
(605) 886-8471
(605) 886-9317
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 886-8471
(605) 886-9317
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1375
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5609073
—
SD
Enumeration date
01/12/2006
Last updated
10/27/2014
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