Provider Demographics
NPI:1114941416
Name:JOHNSON, RYAN KENJI (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:KENJI
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3200 E CAMELBACK RD
Mailing Address - Street 2:STE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2311
Mailing Address - Country:US
Mailing Address - Phone:602-933-1813
Mailing Address - Fax:602-933-1820
Practice Address - Street 1:5983 E GRANT RD
Practice Address - Street 2:STE 117
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2365
Practice Address - Country:US
Practice Address - Phone:602-933-3166
Practice Address - Fax:602-933-4166
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ35247208000000X, 2080P0202X
IA37244208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics