Provider Demographics
NPI:1407720584
Name:JOHNSON, KOBE JAMIR (BSN, RN)
Entity type:Individual
Prefix:
First Name:KOBE
Middle Name:JAMIR
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W LOS FELIZ RD UNIT 330
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3562
Mailing Address - Country:US
Mailing Address - Phone:501-574-2874
Mailing Address - Fax:
Practice Address - Street 1:435 W LOS FELIZ RD UNIT 330
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-3562
Practice Address - Country:US
Practice Address - Phone:501-574-2874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95363700163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine