Basic Information
| Provider Information | |||||||||
| NPI: | 1053639070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | WANG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1424 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257892000 | ||||||||
| FaxNumber: | 4257892096 | ||||||||
| Practice Location | |||||||||
| Address1: | 1424 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257892000 | ||||||||
| FaxNumber: | 4257892096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2010 | ||||||||
| LastUpdateDate: | 12/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A121626 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 60891239 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.