Healthcare Provider Details

I. General information

NPI: 1154654184
Provider Name (Legal Business Name): ROBERT FREDERICK JOHNS O.M.D., L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 DWIGHT WAY SUITE A
BERKELEY CA
94704-2639
US

IV. Provider business mailing address

2000 DWIGHT WAY SUITE A
BERKELEY CA
94704-2639
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-1884
  • Fax:
Mailing address:
  • Phone: 510-548-1884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 2734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: