MD Center for Facial Rejuvenation

Primary specialty

Ophthalmologic Surgery Clinic/CenterTaxonomy code 261QS0132X

License

6139294-1205 Issued in UT

Legal business name

MD CENTER FOR FACIAL REJUVENATION

Practice address

6440 Wasatch Blvd
Suite 390
Salt Lake City, UT 84121-3511

Phone

(801) 424-3223

Fax

(801) 424-3228

NPI assigned

Nov 30, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Justin Rodney Johnsen, M.D.NPI 1679582282

Title

Owner

Phone

(801) 424-3223

Specialties & licenses 1

Addresses

Other names 1

• RenewMD Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin Rodney Johnsen, M.D.

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Salt Lake City, UT
  • NPI 1679582282
  NPD (past) Authorized official

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467520437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6440 WASATCH BLVD",
            "address_2": "SUITE 390",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841213511",
            "telephone_number": "801-424-3223",
            "fax_number": "801-424-3228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6440 WASATCH BLVD",
            "address_2": "SUITE 390",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841213511",
            "telephone_number": "801-424-3223",
            "fax_number": "801-424-3228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD CENTER FOR FACIAL REJUVENATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSEN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "RODNEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-424-3223",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": "UT",
            "license": "6139294-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RenewMD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Richard McVey, PA-C
• Stephanie Browning McVicar
• Dinah McWethy
• Amanda McWhirter
• Robert Kellen McWhorter, DMD
• MDG - Salt Lake City LLC
• MDG- Saltlake City Dental
• Coryann Ledford Mead, PT, DPT
• Kristyn M Meade
• Whitney Elizabeth Meador

• Ophthalmologic Surgery Clinic/Center in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Ophthalmologic Surgery Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.