Healthcare Provider Details

I. General information

NPI: 1861626244
Provider Name (Legal Business Name): DOROTHY KAHN JOHNSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

6372 FENWORTH CT
AGOURA HILLS CA
91301-4104
US

V. Phone/Fax

Practice location:
  • Phone: 213-226-8000
  • Fax: 323-226-3236
Mailing address:
  • Phone: 818-889-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number267832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: