Organization
ALYSSA JOHNSTON REGISTERED NURSING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB SUNG KEUM MD (ATTENDING PHYSICIAN)
(770) 876-9602
Entity
Organization
Contact information
Practice address
1814 CIRBY WAY APT B, ROSEVILLE, CA 95661-5564
(770) 876-9602
Mailing address
1814 CIRBY WAY APT B, ROSEVILLE, CA 95661-5564
(770) 876-9602
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215998737
NPI
—
01
—
1891281432
NPI
—
Enumeration date
04/11/2022
Last updated
04/20/2022
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