Provider Demographics
NPI:1336223346
Name:JOHNSON, JOY A (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 PARALLEL PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1528
Mailing Address - Country:US
Mailing Address - Phone:913-334-4110
Mailing Address - Fax:913-334-9007
Practice Address - Street 1:9201 PARALLEL PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1528
Practice Address - Country:US
Practice Address - Phone:913-334-4110
Practice Address - Fax:913-334-9007
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-193622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSD16906Medicare UPIN
KS041695Medicare ID - Type UnspecifiedKANSAS MEDICARE
KS5349150AMedicare ID - Type UnspecifiedMEDICARE KANSAS CITY