Healthcare Provider Details

I. General information

NPI: 1265596282
Provider Name (Legal Business Name): KURT E JOHNSON MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 MANGROVE AVE STE 10
CHICO CA
95926-3509
US

IV. Provider business mailing address

1026 MANGROVE AVE STE 10
CHICO CA
95926-3509
US

V. Phone/Fax

Practice location:
  • Phone: 530-899-9361
  • Fax: 530-899-9841
Mailing address:
  • Phone: 530-899-9361
  • Fax: 530-899-9841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberG59768
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG59768
License Number StateCA

VIII. Authorized Official

Name: DR. KURT E JOHNSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-899-9361