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General NPI Number Information
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NPI Number | 1942799002
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Entity Type | Individual
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Provider Name | KEVIN WENDELL JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1915 W 5950 S
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City | ROY
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State | UT
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Zip | 84067-1454
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Country | US
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Telephone | 801-387-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 W 5950 S
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City | ROY
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State | UT
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Zip | 84067-1454
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Country | US
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Telephone | 801-387-8100
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Fax |
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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 | 33399
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License Number State | NE
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