Provider Demographics
NPI:1083728190
Name:JOHNSON-CHAVIS, TONI DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:TONI
Middle Name:DENISE
Last Name:JOHNSON-CHAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S LONG BEACH BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3449
Mailing Address - Country:US
Mailing Address - Phone:323-774-6551
Mailing Address - Fax:310-763-2315
Practice Address - Street 1:403 S LONG BEACH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3449
Practice Address - Country:US
Practice Address - Phone:323-774-6551
Practice Address - Fax:310-763-2315
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32796208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-4142115OtherTAX ID