Kenneth Wayne Johnson, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

G83706 Issued in CA

Practice address

711 W College St
Suite M88
Los Angeles, CA 90012-1163

Phone

(213) 625-8825

Fax

(213) 625-8838

NPI assigned

Apr 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Marian a. Fedak M.D. Medical Corporation

  • Specialist
  • Los Angeles, CA
  • NPI 1619077138
  NPD (past)
• Freeman-Oak Hill Health System

  • Multi-Specialty Clinic/Center
  • Joplin, MO
  • NPI 1679517023

  Physical Medicine & Rehabilitation

  NPD (past)
• Sek Otolaryngology

  • Otolaryngic Allergy Physician
  • Pittsburg, KS
  • NPI 1306934633
  NPD (past)
• Shawnee Mission Medical Center, Inc.

  • Urgent Care Clinic/Center
  • Shawnee, KS
  • NPI 1942317854
  NPD (past)

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197244800000",
    "number": "1972560449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 491389",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900499389",
            "telephone_number": "310-351-1495",
            "fax_number": "866-631-5338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W COLLEGE ST",
            "address_2": "SUITE M88",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900121163",
            "telephone_number": "213-625-8825",
            "fax_number": "213-625-8838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENNETH",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2007-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "KS",
            "license": "0428328",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "G83706",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "2006028600",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keaishi L Johnson
• Kelly E Johnson, PHD
• Kelsey Johnson
• Kelsey Ruth Johnson, CRNA
• Kemit B Johnson
• Kent Evan Johnson Jr.
• Keri Dangelo Johnson
• Kimberly Johnson
• Kristina Emery Johnson, MD
• Kristine H Johnson, MFT

• Physical Medicine & Rehabilitation Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.