Provider Demographics
NPI:1861765752
Name:JOHNSON, KORY D
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 MISSION OAKS BLVD # 574
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5400
Mailing Address - Country:US
Mailing Address - Phone:360-421-5953
Mailing Address - Fax:
Practice Address - Street 1:5235 MISSION OAKS BLVD # 574
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5400
Practice Address - Country:US
Practice Address - Phone:360-421-5953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other