Healthcare Provider Details

I. General information

NPI: 1942799002
Provider Name (Legal Business Name): KEVIN WENDELL JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 W 5950 S
ROY UT
84067-1454
US

IV. Provider business mailing address

1915 W 5950 S
ROY UT
84067-1454
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-8100
  • Fax:
Mailing address:
  • Phone: 801-387-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33399
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: