Healthcare Provider Details

I. General information

NPI: 1841245057
Provider Name (Legal Business Name): RANDALL LEE JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4081 EAST OLYMPIC BOULEVARD
LOS ANGELES CA
90023-3330
US

IV. Provider business mailing address

2550 NORTH HOLLYWOOD WAY SUITE 209
BURBANK CA
91505-5019
US

V. Phone/Fax

Practice location:
  • Phone: 323-881-2666
  • Fax: 323-267-4530
Mailing address:
  • Phone: 818-557-0135
  • Fax: 818-557-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG34657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: