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General NPI Number Information
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NPI Number | 1710360094
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Entity Type | Organization
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Legal Business Name | JENNIFER JOHNSON, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/03/2015
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Last Update Date | 07/03/2015
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Provider Practice Location Address
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Address Line | 366 SAN MIGUEL DR STE 209
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7810
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Country | US
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Telephone | 949-856-2701
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Fax |
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Provider Business Mailing Address
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Address Line | 366 SAN MIGUEL DR STE 209
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7810
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Country | US
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Telephone | 949-856-2701
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER JOHNSON
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Credential | M.D.
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Telephone | 949-856-2701
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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 | A40753
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License Number State | CA
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