Provider Demographics
NPI:1548588890
Name:JOHNSON, KNUTE AYHENS (MA)
Entity Type:Individual
Prefix:MR
First Name:KNUTE
Middle Name:AYHENS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:KNUTE
Other - Middle Name:
Other - Last Name:AYHENS-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:901 NEVIN AVE
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3143
Mailing Address - Country:US
Mailing Address - Phone:510-307-1609
Mailing Address - Fax:510-307-1615
Practice Address - Street 1:26081 MOCINE AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-2923
Practice Address - Country:US
Practice Address - Phone:510-881-5921
Practice Address - Fax:510-881-5925
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health