Healthcare Provider Details

I. General information

NPI: 1952523086
Provider Name (Legal Business Name): MARION S JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD STE 817
LOS ANGELES CA
90017-4808
US

IV. Provider business mailing address

9854 NATIONAL BLVD # 473
LOS ANGELES CA
90034-2713
US

V. Phone/Fax

Practice location:
  • Phone: 213-300-2102
  • Fax: 800-586-0181
Mailing address:
  • Phone: 310-804-9741
  • Fax: 800-586-0181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberG40087
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: