MEDICARE: KENDALL JOHNSON PA-C

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	363A00000X	Physician Assistant	61305	CA

General Provider Information

NPI Number	:	1760118160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL JOHNSON PA-C

Provider Business Mailing Address
First Line	:	3581 PALMER DR STE 203
Second Line	:
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-8237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3581 PALMER DR STE 203
Second Line	:
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-8237
Country	:	US
Telephone Number	:	530-676-0119
Fax Number	:

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

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	07/27/2022

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Directions to “ KENDALL JOHNSON PA-C” Practice Location

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