Healthcare Provider Details

I. General information

NPI: 1194658138
Provider Name (Legal Business Name): JOHANNA OLSON-KENNEDY APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE STE 105
PASADENA CA
91105-2536
US

IV. Provider business mailing address

1107 FAIR OAKS AVE # 803
SOUTH PASADENA CA
91030-3311
US

V. Phone/Fax

Practice location:
  • Phone: 866-846-5062
  • Fax:
Mailing address:
  • Phone: 323-399-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHANNA L OLSON-KENNEDY
Title or Position: OWNER
Credential: MD
Phone: 323-399-1087