Provider Demographics
NPI:1730130527
Name:JOHNSON, DANIEL K (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17820 1ST AVE S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1794
Mailing Address - Country:US
Mailing Address - Phone:206-592-5000
Mailing Address - Fax:206-824-9510
Practice Address - Street 1:17820 1ST AVE S
Practice Address - Street 2:SUITE 101
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1723
Practice Address - Country:US
Practice Address - Phone:206-248-3668
Practice Address - Fax:206-244-2499
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000282213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5823620001OtherDME SUPPLIER NUMBER
WAP00309501OtherRR MEDICARE
WA1693407Medicaid
WA1693407Medicaid
WAT01653Medicare UPIN
WAP00309501OtherRR MEDICARE