Healthcare Provider Details

I. General information

NPI: 1114794534
Provider Name (Legal Business Name): JOHNSON HE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 W LA PALMA AVE # 140
ANAHEIM CA
92801-2658
US

IV. Provider business mailing address

728 DAWSON DR
POMONA CA
91766-5767
US

V. Phone/Fax

Practice location:
  • Phone: 714-774-7777
  • Fax:
Mailing address:
  • Phone: 626-228-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number33790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: