MEDICARE: DR. TONI DENISE JOHNSON-CHAVIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A32796	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95-4142115	OTHER	CA	TAX ID

General Provider Information

NPI Number	:	1083728190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONI DENISE JOHNSON-CHAVIS M.D.

Provider Business Mailing Address
First Line	:	403 S LONG BEACH BLVD
Second Line	:	SUITE B
City	:	COMPTON
State	:	CA
Zip	:	90221-3449
Country	:	US
Telephone Number	:	323-774-6551
Fax Number	:	310-763-2315

Provider Business Practice Location Address
First Line	:	403 S LONG BEACH BLVD
Second Line	:	SUITE B
City	:	COMPTON
State	:	CA
Zip	:	90221-3449
Country	:	US
Telephone Number	:	323-774-6551
Fax Number	:	310-763-2315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	06/07/2023

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