Healthcare Provider Details

I. General information

NPI: 1073546925
Provider Name (Legal Business Name): SUSAN H. JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34503 9TH AVE S STE 330
FEDERAL WAY WA
98003-8726
US

IV. Provider business mailing address

34503 9TH AVE S STE 330
FEDERAL WAY WA
98003-8726
US

V. Phone/Fax

Practice location:
  • Phone: 253-383-3695
  • Fax: 253-661-1987
Mailing address:
  • Phone: 253-383-3695
  • Fax: 253-661-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD17446
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD60287595
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: