Provider Demographics
NPI:1659780187
Name:JOHNSON, KATHY N (PHD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3239 EL CAMINO REAL
Mailing Address - Street 2:#210
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2210
Mailing Address - Country:US
Mailing Address - Phone:650-424-9500
Mailing Address - Fax:866-497-1962
Practice Address - Street 1:3239 EL CAMINO REAL
Practice Address - Street 2:#210
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2210
Practice Address - Country:US
Practice Address - Phone:650-424-9500
Practice Address - Fax:866-497-1962
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health