NPIMap

Individual provider Active NPI

Malieka Trinee Johnson, DDS

  • General Practice Dentistry
  • San Diego, CA
National Provider Identifier
1003161969
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
61342 Issued in CA
Practice address
4784 Muir Ave
San Diego, CA 92107-2218
Phone
(619) 518-9000
NPI assigned
Jul 17, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 3361474 ID
Public Health Dentistry 1223D0001X 61342 CA
General Practice Dentistry 1223G0001X 61342 CA Primary

Addresses

Primary practice location

4784 Muir Ave
San Diego, CA 92107-2218

Mailing address

PO Box 881496
San Diego, CA 92168-1496
Phone (619) 518-9000

Other practice location 1

808 Cleveland Blvd
Caldwell, ID 83605-4168
Phone (208) 459-1025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250502001777 ID Practitioner - Dentist 4587972922 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Clinics, Inc. CurrentSince Apr 14, 2025 Accepting new patients
Community Health Clinics, Inc. Current Accepting new patients
Scripps Health Current Accepting new patients
M. Johnson Dental Corporation Current Accepting new patients
Community Health Clinics, Inc. CurrentSince Apr 14, 2025 Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients
Community Health Clinics, Inc. General Practice Past Accepting new patients

Locations

150 2nd St
Melba, ID 83641
Phone (208) 495-1011

3115 E Florence Dr
Meridian, ID 83642
Phone (208) 378-4288

Interoperability endpoints

  • Direct secure messaging: mjohnson794908@direct.ochin.org
  • Direct secure messaging: mjohnson81159@scrippshlth.medalliesdirect.net

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1003161969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 881496",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921681496",
            "telephone_number": "619-518-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4784 MUIR AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921072218",
            "telephone_number": "619-518-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "808 Cleveland Blvd",
            "address_purpose": "LOCATION",
            "city": "Caldwell",
            "state": "ID",
            "postal_code": "836054168",
            "country_code": "US",
            "telephone_number": "208-459-1025",
            "fax_number": "208-466-5359",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MALIEKA",
        "middle_name": "TRINEE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-17",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "3361474",
            "primary": false
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "CA",
            "license": "61342",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "61342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.