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General NPI Number Information
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NPI Number | 1548278534
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Entity Type | Organization
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Legal Business Name | KARL JOHSENS MD & DRUSILLA LDH LEE MD INC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 1595 SOQUEL DR STE 340
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1722
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Country | US
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Telephone | 831-425-1279
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Fax | 831-425-3500
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Provider Business Mailing Address
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Address Line | 1595 SOQUEL DR STE 340
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1722
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Country | US
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Telephone | 831-425-1279
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Fax | 831-425-3500
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Authorized Official
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Title or Position | PHYSICIAN PRESIDENT
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Name | DR. KARL KNUDSEN JOHSEN
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Credential | MD
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Telephone | 831-425-1279
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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 | G084030
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License Number State | CA
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