Provider Demographics
NPI:1457300477
Name:JOHNSON, JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
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 1:450 SUTTER ST RM 933
Mailing Address - Street 2:STE 933
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-3997
Mailing Address - Country:US
Mailing Address - Phone:415-362-5443
Mailing Address - Fax:415-362-2429
Practice Address - Street 1:450 SUTTER ST RM 933
Practice Address - Street 2:STE 933
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-3997
Practice Address - Country:US
Practice Address - Phone:415-362-5443
Practice Address - Fax:415-362-2429
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA065871207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology