Provider Demographics
NPI:1003878448
Name:JOHNSON, KEVIN K (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE250442085R0202X
KS04-366592085R0202X
HI175512085R0202X
CO293832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO300049154OtherRR RIA MEDICARE
KS200425020AMedicaid
CO300090607OtherRR DIA MEDICARE
TX053221001OtherTX MEDICAID
MI104686220OtherMI MEDICAID
CO01293836Medicaid
MO1003878448Medicaid
UT1003878448Medicaid
NE84-059792913Medicaid
WY1003878448Medicaid
MT1003878448Medicaid
NV1003878448Medicaid
OK200427030AMedicaid
LA2192451Medicaid
AZ418800Medicaid
CAXPY204569OtherCA MEDICAID
NE10025709000Medicaid
GA003135486AOtherGA MEDICAID
NY02300136OtherNY MEDICAID
UT1679513196Medicaid
CO300090599OtherRR MIC MEDICARE
NEP00720354OtherRR MCR NE
NC7617652Medicaid
UT1003878448Medicaid
CO391308ZLJ3Medicare PIN
CO300090599OtherRR MIC MEDICARE
OK200427030AMedicaid
AZ418800Medicaid
GA003135486AOtherGA MEDICAID
NEP00720354OtherRR MCR NE
MO1003878448Medicaid
NC7617652Medicaid
LA2192451Medicaid
WY1003878448Medicaid