Provider Demographics
NPI:1972654804
Name:JOHNSON, MIKE (HEARING AID SPECIALI)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:HEARING AID SPECIALI
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:ABEDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HEARING AID SPECIALI
Mailing Address - Street 1:26916 CHERRY HILLS BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586
Mailing Address - Country:US
Mailing Address - Phone:951-672-4940
Mailing Address - Fax:951-672-7631
Practice Address - Street 1:26916 CHERRY HILLS BOULEVARD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586
Practice Address - Country:US
Practice Address - Phone:951-672-4940
Practice Address - Fax:951-672-7631
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3515174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist