MEDICARE: THOMAS L JOHNSON JR. MD

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	208800000X	Urology Physician	C41044	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881765584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS L JOHNSON JR. MD

Provider Business Mailing Address
First Line	:	9100 S SEPULVEDA BLVD STE 121
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4849
Country	:	US
Telephone Number	:	310-674-6785
Fax Number	:	310-674-2161

Provider Business Practice Location Address
First Line	:	9100 S SEPULVEDA BLVD STE 121
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4849
Country	:	US
Telephone Number	:	310-674-6785
Fax Number	:	310-674-2161

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	10/03/2019

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