Individual
JACK W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12377 LEWIS STREET, SUITE #104, GARDEN GROVE, CA 92840-4691
(714) 703-1366
Mailing address
12377 LEWIS STREET, SUITE #104, GARDEN GROVE, CA 92840-4691
(714) 703-1366
(714) 750-0464
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
G21314
CA
Other
Enumeration date
11/14/2006
Last updated
07/08/2007
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