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General NPI Number Information
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NPI Number | 1023281177
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Entity Type | Organization
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Legal Business Name | KIMBERLY D JOHNSON, DO, PA
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 1411 N BECKLEY AVE PAVILION III, STE. 352
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City | DALLAS
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State | TX
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Zip | 75203-1259
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Country | US
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Telephone | 214-943-2249
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Fax | 214-943-8213
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Provider Business Mailing Address
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Address Line | 1411 N BECKLEY AVE PAVILION III, STE. 352
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City | DALLAS
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State | TX
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Zip | 75203-1259
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Country | US
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Telephone | 214-943-2249
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Fax | 214-943-8213
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Authorized Official
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Title or Position | SOLE DIRECTOR
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Name | DR. KIMBERLY D JOHNSON
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Credential | D.O.
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Telephone | 972-948-3518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L3098
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License Number State | TX
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