Provider Demographics
NPI:1255599304
Name:JOHNSON, DORIS L (LAC)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5635
Mailing Address - Country:US
Mailing Address - Phone:310-475-8018
Mailing Address - Fax:310-475-7818
Practice Address - Street 1:1736 WESTWOOD BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5635
Practice Address - Country:US
Practice Address - Phone:310-475-8018
Practice Address - Fax:310-475-7818
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6484171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist