Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 32659 | MN |
NPI | 1093778664 |
---|---|
Provider Name | Kenneth A Johns |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Coon Rapids, MN 55433-5841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 11/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
161587400 | (05) | MN |
B53882 | (02) |