MEDICARE: DR. DIANE L. JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	G62317	CA
2	207RP1001X	Pulmonary Disease Physician	G62317	CA
3	207R00000X	Internal Medicine Physician	G62317	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	810000525	OTHER	CA	GOOD SAM RAILROAD
2	00G623170	OTHER	CA	CALOPTIMA
3	G62317	OTHER	CA	BLUE CROSS
4	00G623170	OTHER	CA	BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013962273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE L. JOHNSON M.D.

Provider Business Mailing Address
First Line	:	65 PINE AVE
Second Line	:	#19
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4718
Country	:	US
Telephone Number	:	714-402-4685
Fax Number	:	562-856-0389

Provider Business Practice Location Address
First Line	:	65 PINE AVE
Second Line	:	#19
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4718
Country	:	US
Telephone Number	:	714-402-4685
Fax Number	:	562-856-0389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	05/07/2009

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Directions to “ DR. DIANE L. JOHNSON M.D.” Practice Location

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