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Individual

KENNETH D JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
13300 E HIGHWAY 20, CLEARLAKE OAKS, CA 95423-9436
(707) 998-0310
Mailing address
PO BOX 1024, LUCERNE, CA 95458-1024
(707) 274-9101

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-YDOIKM
CA

Other

Enumeration date
04/17/2025
Last updated
04/17/2025
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