Provider Demographics
NPI:1053591198
Name:JOHNSTON, KELLY DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:DEAN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7910 FROST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2776
Mailing Address - Country:US
Mailing Address - Phone:858-278-8300
Mailing Address - Fax:858-278-1708
Practice Address - Street 1:7910 FROST ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2776
Practice Address - Country:US
Practice Address - Phone:858-278-8300
Practice Address - Fax:858-278-1708
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101851207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery