Basic Information
| Provider Information | |||||||||
| NPI: | 1972846293 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 HANCOCK ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021694339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177740840 | ||||||||
| FaxNumber: | 6177740882 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 HANCOCK ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021694339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177740840 | ||||||||
| FaxNumber: | 6177740882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2013 | ||||||||
| LastUpdateDate: | 02/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 267151 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.