Phillip Randolph Johnson

Primary specialty

DentistTaxonomy code 122300000X

License

51943 Issued in CA

Practice address

5454 El Cajon Blvd
San Diego, CA 92115-3621

Phone

(619) 515-2400

NPI assigned

Aug 29, 2006

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1356450159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-906-4623",
            "fax_number": "619-906-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5454 EL CAJON BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921153621",
            "telephone_number": "619-515-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Vale Terrace Dr",
            "address_purpose": "LOCATION",
            "city": "Vista",
            "state": "CA",
            "postal_code": "920845218",
            "country_code": "US",
            "telephone_number": "760-407-1220 x109",
            "fax_number": "760-414-3702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "PHILLIP",
        "middle_name": "RANDOLPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "51943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole S. Johnson
• Patricia Ann Johnson, RRW
• Patricia Ann Johnson, NP
• Patricia M Johnson, NP
• Penny Johnson, CADC II, CACCS
• Priya Johnson
• R Bruce Johnson, M.D.
• Ralph Sellers Johnson, M.D.
• Rashad Adrian Johnson, M.A.
• Rebecca J Johnson, LCSW 29018

• Dentist in San Diego, CA
• Providers in San Diego, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.