Provider Demographics
NPI:1295046472
Name:JOHNSON, KRISTIN HOKANSON (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:HOKANSON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:HOKANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5111 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2201
Mailing Address - Country:US
Mailing Address - Phone:952-922-4300
Mailing Address - Fax:952-922-4301
Practice Address - Street 1:5111 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2201
Practice Address - Country:US
Practice Address - Phone:952-922-4300
Practice Address - Fax:952-922-4301
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN54137208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MN370004477Medicare PIN