Active NPI
S Shaun Johanson, DDS
- General Practice Dentistry
- McKinleyville, CA
National Provider Identifier
1295866804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 40838
- Practice address
- 1661 Pickett Rd
McKinleyville, CA 95519-3914 - Phone
- (707) 839-3227
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 40838 | CA | Primary |
Addresses
Primary practice location
1661 Pickett Rd
McKinleyville, CA 95519-3914
Mailing address
PO Box 2368
McKinleyville, CA 95519-2368
Phone (707) 839-3227
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B40838-01 | Other | CA | DENTICAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| S. Shaun Johanson DDS, Inc. | General Practice | Past | Accepting new patients |
| Lawrence G Johanson DDS, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- McKinleyville, CA
- NPI 1003947623
-
- Dental Clinic/Center
- McKinleyville, CA
- NPI 1598931974
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592956800000",
"number": "1295866804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2368",
"city": "MCKINLEYVILLE",
"state": "CA",
"postal_code": "955192368",
"telephone_number": "707-839-3227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1661 PICKETT RD",
"city": "MCKINLEYVILLE",
"state": "CA",
"postal_code": "955193914",
"telephone_number": "707-839-3227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHANSON",
"first_name": "S",
"middle_name": "SHAUN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-07",
"last_updated": "2020-06-24",
"certification_date": "2020-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "40838",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTICAL",
"identifier": "B40838-01",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in McKinleyville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.