1891748992 NPI number — DR. LESLIE MARTIN JOHNSON JR. PSYD

Table of content: DR. LESLIE MARTIN JOHNSON JR. PSYD (NPI 1891748992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891748992 NPI number — DR. LESLIE MARTIN JOHNSON JR. PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
LESLIE
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PSYD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
L
Provider Other Middle Name:
MARTIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1891748992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 BISHOP STREET
Provider Second Line Business Mailing Address:
SUITE 2870
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-3482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-538-7793
Provider Business Mailing Address Fax Number:
808-538-7799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 BISHOP STREET
Provider Second Line Business Practice Location Address:
SUITE 2870
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-3482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-538-7793
Provider Business Practice Location Address Fax Number:
808-538-7799
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY 736 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000230755 . This is a "HMSA QUEST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 99-0351398 . This is a "HMA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 611304000 . This is a "US DEPT. OF LABOR" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 99-0351395 . This is a "HMAA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000230755 . This is a "HMSA 65C PLUS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 99-0351398 . This is a "KAISER ADDED CHOICE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 99-0351398 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 50206402 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99-0351398 . This is a "WPS-TRICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 230755 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 230755 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 50206401 . This is a "ALOHACARE (QUEST)" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 99-0351398 . This is a "FEI BEHAVIORAL HEALTH" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 99-0351398 . This is a "HMA-SUMMERLINE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 99-0351398 . This is a "MDX (QUEEN'S) HAWAII" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000230755 . This is a "HMSA CCS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 230755 . This is a "BC/BS; UNITED GOV. SVC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 99-0351398 . This is a "AIG-NO FAULT INS." identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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