Provider Demographics
NPI:1114794534
Name:HE, JOHNSON
Entity Type:Individual
Prefix:
First Name:JOHNSON
Middle Name:
Last Name:HE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 DAWSON DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-5767
Mailing Address - Country:US
Mailing Address - Phone:626-228-6339
Mailing Address - Fax:
Practice Address - Street 1:2441 W LA PALMA AVE # 140
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2658
Practice Address - Country:US
Practice Address - Phone:714-774-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33790227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered