Provider Demographics
NPI:1750449229
Name:JOHNSON, PAUL BENNETT (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BENNETT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7230 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE #500
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1907
Mailing Address - Country:US
Mailing Address - Phone:818-348-7246
Mailing Address - Fax:818-348-7248
Practice Address - Street 1:7230 MEDICAL CENTER DR
Practice Address - Street 2:SUITE #500
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1907
Practice Address - Country:US
Practice Address - Phone:818-348-7246
Practice Address - Fax:818-348-7248
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA93613207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine