Healthcare Provider Details

I. General information

NPI: 1891861308
Provider Name (Legal Business Name): KAREN SUE JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 05/21/2023
Certification Date: 05/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5017 PALMETTO AVE APT 68
PACIFICA CA
94044-1036
US

IV. Provider business mailing address

5017 PALMETTO AVE APT 68
PACIFICA CA
94044-1036
US

V. Phone/Fax

Practice location:
  • Phone: 415-647-2353
  • Fax: 888-960-9079
Mailing address:
  • Phone: 415-647-2353
  • Fax: 888-960-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number301041281
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC41861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: