MR. STEPHAN LEE JOHNSON (NPI# 1568799880) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568799880 |
| Entity Type | Individual |
| Full Name | MR. STEPHAN LEE JOHNSON |
| Credential | PA-C |
| Practice Address |
4060 Fairmount Ave San Diego CA 92105-1608 |
| Practice Telephone | 6192804213 |
| Practice Fax Number | 6192803545 |
| Mailing Telephone | 6192804213 |
| Mailing Fax Number | 6192803545 |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2011-12-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA16986 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4060 FAIRMOUNT AVE |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92105-1608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932104981 | Sombath Senethong | Family Medicine | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2005-06-16 |
| 1811594286 | Nathanael Jonathan Luna | Pharmacist | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2020-10-07 |
| 1184243420 | Soona Ko | Student in an Organized Health Care Education/Training Program | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2020-04-15 |
| 1780233098 | Cristina L Kim | Nurse Practitioner | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2019-09-09 |
| 1275189110 | Jessica Wilson | Nurse Practitioner | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2019-08-15 |
| 1073177739 | La Maestra Family Clinic, Inc. | Clinic/Center | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2019-04-29 |
| 1982181772 | Vahid Niki | Dentist | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2018-07-24 |
| 1417446477 | Kellie Ramsey | Dentist | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2018-05-05 |
| 1528586716 | Emilia Kodiath | Dentist | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2017-09-07 |
| 1659814648 | Iran Felix | Nurse Practitioner | 4060 Fairmount Ave, San Diego, CA 92105-1608 | 2016-11-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851934798 | Point Loma Nazarene University | Nurse Practitioner | Point Loma Nazarene University Health Promotion Center, 4101 University Avenue, San Diego, CA 92105 | 2019-10-23 |
| 1104478809 | Kristin Lynn Nichols | Counselor | 4823 El Cajon Blvd Suite #115, San Diego, CA 92105 | 2019-07-12 |
| 1205343076 | Momentum Learning | Counselor | 3720 El Cajon Blvd., Sd, CA 92105 | 2018-01-03 |
| 1306352695 | Nathan Hien Le, Dds. Inc | Dentist | 4170 Fairmount Ave., San Diego, CA 92105 | 2017-12-21 |
| 1073038071 | Aika Mary Erlandson | Student in an Organized Health Care Education/Training Program | 5296 University Ave. Suite F-2, San Diego, CA 92105 | 2017-08-10 |
| 1457872178 | Ride-in Transport LLC | Non-emergency Medical Transport (VAN) | 4061 Fairmount Ave, San Diego, CA 92105 | 2017-07-03 |
| 1598205346 | Ahmed Mooge | Ambulance | 4061 Fairmout Ave, San Diego, CA 92105 | 2017-02-27 |
| 1083152748 | Rady Childrens Hospital-san Diego | Psychiatric Unit | 4305 University Avenue, Suite 150, San Diego, CA 92105 | 2017-02-02 |
| 1730634098 | Med Specialty Sai Inc. | Pharmacy | 4153 University Avenue, Suite B, San Diego, CA 92105 | 2016-08-16 |
| 1568857464 | Dr. Jeffrey A. Saladin, Dental Corporation | Dentist | 4074 Fairmount Avenue, Suite B, San Diego, CA 92105 | 2015-03-30 |
| Find all providers in zip 92105 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528610870 | Josephine Hoa Ngoc Mai | Physician Assistant | 3050 Rue Dorleans Unit 291, San Diego, CA 92110-5904 | 2019-07-16 |
| 1962966309 | Tashina Jessica Kraintz | Physician Assistant | 10431 Caminito Alvarez, San Diego, CA 92126-5838 | 2019-01-30 |
| 1801314042 | Erika Dimitra Couris | Physician Assistant | 3969 Fourth Ave, #301, San Diego, CA 92103-9210 | 2017-09-08 |
| 1871859421 | Lisa Nakhleh Boyd | Physician Assistant | 2999 Health Center Drive, San Diego, CA 92123 | 2012-04-09 |
| 1760759104 | Brandon William Schroth | Physician Assistant | 357051 Nasni, Commander Naval Air Forces, San Diego, CA 92135-7051 | 2011-11-30 |
| 1891080750 | Jennifer K Nguyen | Physician Assistant | 1466 Mariposa Street, San Diego, CA 92114-3612 | 2011-06-17 |
| 1942510698 | Laurie Anne Reeves | Physician Assistant | 6367 Alvardo Ct., Suite #200, San Diego, CA 92120 | 2010-10-15 |
| 1568783108 | Monica Gable | Physician Assistant | 2929 Health Center Dr., San Diego, CA 92123-7741 | 2010-06-17 |
| 1932422698 | Debbie Lo Flores | Physician Assistant | 5030 Camino De La Siesta Ste 204, San Diego, CA 92108-3118 | 2010-03-10 |
| 1801125034 | Lindsey R Hayes | Physician Assistant | Quentin Roosevelt Blvd, Building 8, San Diego, CA 92135-7051 | 2009-12-17 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.