Provider Demographics
NPI:1295707289
Name:JOHNSON, KATHERINE C (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:C
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:PO BOX 50095
Mailing Address - Street 2:HALL HEALTH PRIMARY CARE CENTER
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:315 E STEVENS CIRCLE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195
Practice Address - Country:US
Practice Address - Phone:206-685-1031
Practice Address - Fax:206-616-4683
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033343207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0245571OtherL&I
WA8234940Medicaid
WA8234940Medicaid
WA8878964Medicare PIN
217127700Medicare ID - Type Unspecified
G83245Medicare UPIN