Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G84030 | CA |
Y | 111NI0900X | Internist | G84030 | CA |
N | 207RH0002X | Hospice and Palliative Medicine | G084030 | CA |
NPI | 1295948727 |
---|---|
Provider Name | Dr. Karl Knudsen Johsens |
First Address | Santa Cruz, CA 95065-1722 |
Second Address | Santa Cruz, CA 95065-1722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 11/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G840300 | (05) | CA |
00G840300 | BLUE SHIELD (01) | CA |
110208332 | MEDICARE RAILROAD (01) | CA |
5541296 | AETNA (01) | CA |
G054030 | BLUE CROSS (01) | CA |
G24597 | (02) | CA |