MEDICARE: KENNETH S JOHNSON, M.D., 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	207L00000X	Anesthesiology Physician	A43322	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	:	1346321114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH S JOHNSON, M.D., INC.

Provider Business Mailing Address
First Line	:	PO BOX 4259
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-4259
Country	:	US
Telephone Number	:	562-407-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	18685 MAIN ST # A
Second Line	:	SUITE 600
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-1723
Country	:	US
Telephone Number	:	562-407-2080
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENNETH S JOHNSON
Credential	:	M.D.
Telephone Number	:	562-407-2080

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	05/19/2008

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