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General NPI Number Information
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NPI Number | 1194658138
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Entity Type | Organization
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Legal Business Name | JOHANNA OLSON-KENNEDY APMC
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 301 S FAIR OAKS AVE STE 105
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City | PASADENA
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State | CA
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Zip | 91105-2536
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Country | US
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Telephone | 866-846-5062
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 FAIR OAKS AVE # 803
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3311
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Country | US
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Telephone | 323-399-1087
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHANNA L OLSON-KENNEDY
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Credential | MD
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Telephone | 323-399-1087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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