Healthcare Provider Details

I. General information

NPI: 1245457407
Provider Name (Legal Business Name): LAURANCE FOLKEY JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 E. DEL MAR BIVD. SUITE 7
PASADENA CA
91107
US

IV. Provider business mailing address

2525 MONTEREY RD
SAN MARINO CA
91108-1645
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-5480
  • Fax:
Mailing address:
  • Phone: 626-441-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG017122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: