Active NPI
Kaelyn Maxine Johnson, RD
- Registered Dietitian
- Carson, CA
National Provider Identifier
1982231296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86104310
- Practice address
- 306 Monterey Dr
Carson, CA 90745-6446 - Phone
- (323) 872-2522
- NPI assigned
- Mar 25, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86104310 | CA | Primary |
Addresses
Primary practice location
306 Monterey Dr
Carson, CA 90745-6446
Mailing address
306 Monterey Dr
Carson, CA 90745-6446
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86104310 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585353600000",
"number": "1982231296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 MONTEREY DR",
"city": "CARSON",
"state": "CA",
"postal_code": "907456446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 MONTEREY DR",
"city": "CARSON",
"state": "CA",
"postal_code": "907456446",
"telephone_number": "323-872-2522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KAELYN",
"middle_name": "MAXINE",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-25",
"last_updated": "2020-03-28",
"certification_date": "2020-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86104310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carson, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.