Provider Demographics
NPI:1811125016
Name:JOHNSON, SARA LIVINGSTON (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LIVINGSTON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JOHNSON
Other - Last Name:KERREST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 22210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94623-2210
Mailing Address - Country:US
Mailing Address - Phone:510-504-8562
Mailing Address - Fax:
Practice Address - Street 1:3451 EAST 12TH ST
Practice Address - Street 2:TRANSIT VILLAGE WOMEN'S 2ND FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3425
Practice Address - Country:US
Practice Address - Phone:510-535-3377
Practice Address - Fax:510-535-4248
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 103367207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology