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1588628739

NPI Code Detail

MEDICARE: DR. KENNETH B JOHNSON MD

MEDICARE: DR. KENNETH B JOHNSON MD

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	207RC0000X	Cardiovascular Disease Physician	J8608	TX
2	207UN0901X	Nuclear Cardiology Physician	J8608	TX
3	207RI0011X	Interventional Cardiology Physician	J8608	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588628739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH B JOHNSON MD

Provider Business Mailing Address
First Line	:	9330 LBJ FWY STE 800
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-4310
Country	:	US
Telephone Number	:	972-792-5700
Fax Number	:	214-506-1107

Provider Business Practice Location Address
First Line	:	12720 HILLCREST RD STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2089
Country	:	US
Telephone Number	:	214-814-1550
Fax Number	:	214-814-1350

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	05/30/2024

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Directions to “ DR. KENNETH B JOHNSON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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