Provider Demographics
NPI:1477794105
Name:JOHNSON, CHRISTOPHER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:BOX 175
Mailing Address - Street 2:302A WEST 12TH STREET
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014
Mailing Address - Country:US
Mailing Address - Phone:212-206-6996
Mailing Address - Fax:212-636-4992
Practice Address - Street 1:22 W 48TH ST
Practice Address - Street 2:STE 300
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-1818
Practice Address - Country:US
Practice Address - Phone:877-866-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229970207Q00000X, 208200000X
CAG77562208200000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG77562OtherCALIFORNIA MEDICAL BOARD NUMBER
NY229970OtherNEW YORK MEDICAL BOARD
CAG77562OtherCALIFORNIA MEDICAL BOARD NUMBER
NY229970OtherNEW YORK MEDICAL BOARD