1780676726 NPI number — MRS. DANA ILENE JOHNSON LMP, MMP

Table of content: DR. JULIE KANG PHARM.D. (NPI 1922426758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780676726 NPI number — MRS. DANA ILENE JOHNSON LMP, MMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
DANA
Provider Middle Name:
ILENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMP, MMP
Provider Gender Code:
F

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:
1780676726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25506 157TH AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98042-4161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-435-1285
Provider Business Mailing Address Fax Number:
253-445-8632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11803 101ST AVE CT E
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98373-3473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-435-1285
Provider Business Practice Location Address Fax Number:
253-445-8632
Provider Enumeration Date:
08/16/2005

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: 225700000X , with the licence number:  MA00014833 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0195842 . This is a "L AND I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1880J0 . This is a "REGENCE" identifier . This identifiers is of the category "OTHER".




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