Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35247 | AZ |
N | 208000000X | Pediatrician | 37244 | IA |
Y | 2080P0202X | Pediatric Cardiologist | 35247 | AZ |
NPI | 1114941416 |
---|---|
Provider Name | Dr. Ryan Kenji Johnson |
First Address | Phoenix, AZ 85018-2311 |
Second Address | Tucson, AZ 85712-2365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 01/02/2017 |