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General NPI Number Information
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NPI Number | 1558700054
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Entity Type | Individual
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Provider Name | KENDRICK O JOHNSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 2000 W BETHANY HOME RD
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City | PHOENIX
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State | AZ
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Zip | 85015-2443
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Country | US
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Telephone | 602-249-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 8514 W DEER VALLEY RD STE 105
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City | PEORIA
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State | AZ
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Zip | 85382
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Country | US
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Telephone | 623-226-8825
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Fax | 623-226-8835
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6702
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License Number State | AZ
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