Healthcare Provider Details

I. General information

NPI: 1730130527
Provider Name (Legal Business Name): DANIEL K JOHNSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17820 1ST AVE S SUITE 101
BURIEN WA
98148-1723
US

IV. Provider business mailing address

17820 1ST AVE S SUITE 101
BURIEN WA
98148-1794
US

V. Phone/Fax

Practice location:
  • Phone: 206-248-3668
  • Fax: 206-244-2499
Mailing address:
  • Phone: 206-592-5000
  • Fax: 206-824-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000282
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: