MEDICARE: DR. DANIEL JOHNSON D.O.

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	207Q00000X	Family Medicine Physician	20A9393	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FHC70394F	OTHER		MEDI CAL

General Provider Information

NPI Number	:	1245311216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JOHNSON D.O.

Provider Business Mailing Address
First Line	:	3250 FORDHAM ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5339
Country	:	US
Telephone Number	:	833-574-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 FORDHAM ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5339
Country	:	US
Telephone Number	:	833-574-2273
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/16/2025

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