Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 229970 | NY |
Y | 208200000X | Surgeon | 229970 | NY |
Y | 208600000X | Surgeon | 229970 | NY |
N | 208200000X | Surgeon | G77562 | CA |
N | 208600000X | Surgeon | G77562 | CA |
N | 2086S0127X | Trauma Surgeon | G77562 | CA |
NPI | 1477794105 |
---|---|
Provider Name | Dr. Christopher Lynn Johnson |
First Address | New York, NY 10014 |
Second Address | New York, NY 10036-1818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2009 |
Last Update Date | 05/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000 | (02) | CA |
229970 | NEW YORK MEDICAL BOARD (01) | NY |
G77562 | CALIFORNIA MEDICAL BOARD NUMBER (01) | CA |
UNKNOWN | (02) | CA |