Provider Demographics
NPI:1295948727
Name:JOHSENS, KARL KNUDSEN (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:KNUDSEN
Last Name:JOHSENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 SOQUEL DR STE 340
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1722
Mailing Address - Country:US
Mailing Address - Phone:831-425-1279
Mailing Address - Fax:831-425-3500
Practice Address - Street 1:1595 SOQUEL DR STE 340
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1722
Practice Address - Country:US
Practice Address - Phone:831-425-1279
Practice Address - Fax:831-425-3500
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG084030207RH0002X
CAG84030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5541296OtherAETNA
CA00G840300OtherBLUE SHIELD
CA00G840300Medicaid
CAG054030OtherBLUE CROSS
CA110208332OtherMEDICARE RAILROAD
CA00G840300Medicare ID - Type UnspecifiedMEDICARE
CAG054030OtherBLUE CROSS