Jennifer Johnson, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

A40753 Issued in CA

Practice address

366 San Miguel Dr
Suite 209
Newport Beach, CA 92660-7817

Phone

(949) 856-2701

Fax

(949) 625-7516

NPI assigned

Jun 16, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1982648192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9996",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926581996",
            "telephone_number": "949-856-2701",
            "fax_number": "949-625-7516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "366 SAN MIGUEL DR",
            "address_2": "SUITE 209",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607817",
            "telephone_number": "949-856-2701",
            "fax_number": "949-625-7516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A40753",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "A40753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "A40753",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abigail D Johnson, P.T.
• Amanda Bella Johnson
• Bryan Christopher Johnson, AMFT
• Cody Allen Johnson
• Elizabeth Johnson
• Jordan Matthew Johnson, D.C.
• Kaylynn Ciann Johnson
• Lauren Johnson, AMFT
• Matthew Johnson
• Nicole S Johnson, LMFT

• Pediatric Adolescent Medicine Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Pediatric Adolescent Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.