Provider Demographics
NPI:1891861308
Name:JOHNSON, KAREN SUE (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 PALMETTO AVE APT 68
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1036
Mailing Address - Country:US
Mailing Address - Phone:415-647-2353
Mailing Address - Fax:888-960-9079
Practice Address - Street 1:5017 PALMETTO AVE APT 68
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1036
Practice Address - Country:US
Practice Address - Phone:415-647-2353
Practice Address - Fax:888-960-9079
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3010412812084P0800X
CAC418612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI301041281OtherPHYSICIAN LICENSE
1891861308OtherNPI
CAC41861OtherMEDICAL LICENSE
MI301041281OtherPHYSICIAN LICENSE