Individual
DR. KENNETH ANDREW JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3500 BARRANCA PKWY STE 130, IRVINE, CA 92606-8227
(949) 552-6266
Mailing address
PO BOX 5486, ORANGE, CA 92863-5486
(818) 550-0900
(505) 293-1524
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A65948
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A659480
BLUE SHIELD ID #
CA
05
—
00A659480
—
CA
01
—
00A659480385
CALOPTIMA ID #
CA
01
—
050081654
RAILROAD MEDICARE ID #
CA
Enumeration date
08/17/2006
Last updated
09/26/2011
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