MEDICARE: DR. SEBASTIAN JOHNSON SASU 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A89268	CA

General Provider Information

NPI Number	:	1548387095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEBASTIAN JOHNSON SASU M.D.

Provider Business Mailing Address
First Line	:	1328 22ND ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2032
Country	:	US
Telephone Number	:	310-829-8101
Fax Number	:	310-829-6509

Provider Business Practice Location Address
First Line	:	383 E GRAND AVE STE A
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-6234
Country	:	US
Telephone Number	:	650-616-2951
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	11/05/2024

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