Individual provider Active NPI

Kawne Lee Johnson

  • Marriage & Family Therapist
  • West Covina, CA
National Provider Identifier
1255165759
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
AMFT142493 Issued in CA
Practice address
1539 W Garvey Ave N
West Covina, CA 91790-2139
Phone
(626) 814-6523
NPI assigned
Aug 27, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X AMFT142493 CA Primary

Addresses

Primary practice location

1539 W Garvey Ave N
West Covina, CA 91790-2139

Mailing address

1539 W Garvey Ave N
West Covina, CA 91790-2139

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250303000897 CA Practitioner - Marriage and Family Therapist 2860913225 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AMFT142493CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 22, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 22, 2024 Accepting new patients

Locations

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

1539 W Garvey Ave N
West Covina, CA 91790
Phone (626) 856-3092

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1724716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1255165759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1539 W GARVEY AVE N",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1539 W GARVEY AVE N",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902139",
            "telephone_number": "626-814-6523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE JOHNSON",
        "first_name": "KAWNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-27",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "AMFT142493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Covina, CA

Sources for this page

Verify at the official NPI Registry.