Provider Demographics
NPI:1912134677
Name:JOHNSON, ARIK (PSYD)
Entity type:Individual
Prefix:
First Name:ARIK
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480489
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1489
Mailing Address - Country:US
Mailing Address - Phone:323-868-9567
Mailing Address - Fax:
Practice Address - Street 1:300 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE B200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8346
Practice Address - Country:US
Practice Address - Phone:310-825-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22217103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PSY222170Medicaid
CA00PSY222170Medicaid
CACA559ZMedicare PIN