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NPI Code Detail

MEDICARE: HENRY STEWART JOHNSON

MEDICARE:   HENRY STEWART JOHNSON
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
1207R00000XInternal Medicine PhysicianG46419CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G46419OTHERCAMEDICAL LIC NUMBER

General Provider Information

NPI Number : 1760727614
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY STEWART JOHNSON
Provider Business Mailing Address
First Line : 115 PINE AVE
Second Line : SUITE 615
City : LONG BEACH
State : CA
Zip : 90802-4457
Country : US
Telephone Number : 562-436-9080
Fax Number : 562-435-8303
Provider Business Practice Location Address
First Line : 115 PINE AVE
Second Line : SUITE 615
City : LONG BEACH
State : CA
Zip : 90802-4457
Country : US
Telephone Number : 562-436-9080
Fax Number : 562-435-8303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2012
Last Update Date : 05/04/2016

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Directions to “ HENRY STEWART JOHNSON ” Practice Location

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