1003878448 NPI number — KEVIN K JOHNSON MD

Table of content: KEVIN K JOHNSON MD (NPI 1003878448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003878448 NPI number — KEVIN K JOHNSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
KEVIN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003878448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10800 E GEDDES AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-3895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-761-9190
Provider Business Mailing Address Fax Number:
720-874-4462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 E HAMPDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113-2702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-761-9190
Provider Business Practice Location Address Fax Number:
720-874-4462
Provider Enumeration Date:
04/03/2006

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: 2085R0202X , with the licence number:  25044 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 04-36659 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 17551 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 29383 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300049154 . This is a "RR RIA MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 200425020A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300090607 . This is a "RR DIA MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 053221001 . This is a "TX MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 104686220 . This is a "MI MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01293836 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003878448 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003878448 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84-059792913 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003878448 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003878448 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003878448 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200427030A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2192451 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 418800 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: XPY204569 . This is a "CA MEDICAID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 10025709000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003135486A . This is a "GA MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 02300136 . This is a "NY MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1679513196 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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