MEDICARE: W IRVING JOHNSON MD INC

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	207R00000X	Internal Medicine Physician	C36088	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093799942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W IRVING JOHNSON MD INC

Provider Business Mailing Address
First Line	:	418 30TH STREET
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-3302
Country	:	US
Telephone Number	:	510-208-5100
Fax Number	:	510-465-6810

Provider Business Practice Location Address
First Line	:	418 30TH STREET
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-3302
Country	:	US
Telephone Number	:	510-208-5100
Fax Number	:	510-465-6810

Authorized Official
Title or Position	:	CORP PRESIDENT PHYSICIAN
Name	:	WILLIAM IRVING JOHNSON
Credential	:	MD
Telephone Number	:	510-208-5100

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	12/17/2009

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Directions to “W IRVING JOHNSON MD INC ” Practice Location

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