Individual
DR. JENNIFER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
366 SAN MIGUEL DR, SUITE 209, NEWPORT BEACH, CA 92660-7817
(949) 856-2701
(949) 625-7516
Mailing address
PO BOX 9996, NEWPORT BEACH, CA 92658-1996
(949) 856-2701
(949) 625-7516
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
A40753
CA
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
A40753
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A40753
MEDICAL LICENSE
CA
Enumeration date
06/16/2006
Last updated
03/07/2023
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