Provider Demographics
NPI:1346308756
Name:JOHNSON, VEASSA GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:VEASSA
Middle Name:GAIL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4760 S FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-3159
Mailing Address - Country:US
Mailing Address - Phone:323-232-2601
Mailing Address - Fax:323-232-1924
Practice Address - Street 1:1403 LOMITA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2085
Practice Address - Country:US
Practice Address - Phone:424-263-5260
Practice Address - Fax:424-263-5268
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2025-01-22
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Provider Licenses
StateLicense IDTaxonomies
CAG32489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91449Medicare UPIN