Provider Demographics
NPI:1285823427
Name:JOHNSON, WILLIAM IRVING (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:IRVING
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:W
Other - Middle Name:IRVING
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5950 HARBORD DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3125
Mailing Address - Country:US
Mailing Address - Phone:510-658-4425
Mailing Address - Fax:
Practice Address - Street 1:5950 HARBORD DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-3125
Practice Address - Country:US
Practice Address - Phone:510-658-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C360880Medicaid
CA00C360880Medicaid
A36165Medicare UPIN