Basic Information
| Provider Information | |||||||||
| NPI: | 1053591198 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7910 FROST ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582788300 | ||||||||
| FaxNumber: | 8582781708 | ||||||||
| Practice Location | |||||||||
| Address1: | 7910 FROST ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582788300 | ||||||||
| FaxNumber: | 8582781708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2007 | ||||||||
| LastUpdateDate: | 11/06/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | A101851 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | A101851 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
No ID Information.