Provider Demographics
NPI:1306627807
Name:KYLE JOHNSON PLLC
Entity type:Organization
Organization Name:KYLE JOHNSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-324-3549
Mailing Address - Street 1:350 23RD AVENUE E
Mailing Address - Street 2:STE 102
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-7402
Mailing Address - Country:US
Mailing Address - Phone:213-324-3549
Mailing Address - Fax:
Practice Address - Street 1:350 23RD AVENUE E
Practice Address - Street 2:STE 102
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-7402
Practice Address - Country:US
Practice Address - Phone:213-324-3549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty