Healthcare Provider Details

I. General information

NPI: 1295948727
Provider Name (Legal Business Name): KARL KNUDSEN JOHSENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 SOQUEL DR STE 340
SANTA CRUZ CA
95065-1722
US

IV. Provider business mailing address

1595 SOQUEL DR STE 340
SANTA CRUZ CA
95065-1722
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-1279
  • Fax: 831-425-3500
Mailing address:
  • Phone: 831-425-1279
  • Fax: 831-425-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberG084030
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG84030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: