MEDICARE: KRISTI JOHNSON LEER PA

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	363AS0400X	Surgical Physician Assistant	PA16571	CA
2	363A00000X	Physician Assistant	PA16571	CA

General Provider Information

NPI Number	:	1356376842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI JOHNSON LEER PA

Provider Business Mailing Address
First Line	:	PO BOX 320896
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-0114
Country	:	US
Telephone Number	:	925-556-3110
Fax Number	:	925-556-3110

Provider Business Practice Location Address
First Line	:	2581 SAMARITAN DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-4113
Country	:	US
Telephone Number	:	510-303-3075
Fax Number	:	925-362-0695

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/11/2022

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Directions to “ KRISTI JOHNSON LEER PA” Practice Location

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