Most Relevant Information
Provider Data
| NPI Number: | 1003666819 |
| Provider Name: | KENNETH JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/25/2024 |
| Last Updated: | 03/25/2024 |
Provider Practice Location
344 E 100 S
SALT LAKE CITY
UT
841111700
Practice Location Phone/Fax
| Phone: | 8014284257 |
| Fax: |
Provider Mailing Location
344 E 100 S
SALT LAKE CITY
UT
841111700
Provider Mailing Phone/Fax
| Phone: | 8014284257 |
| Fax: |