Healthcare Provider Details

I. General information

NPI: 1477715696
Provider Name (Legal Business Name): KAALAN E JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2008
Last Update Date: 07/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE OA.9.220 - OTOLARYNGOLOGY-ENT
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE OA.9.220 - OTOLARYNGOLOGY-ENT
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-3468
  • Fax: 206-987-3925
Mailing address:
  • Phone: 206-987-3468
  • Fax: 206-987-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number35.097031
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberMD 60340296
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: