Provider Demographics
NPI:1053742965
Name:JOHANNA POON OD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JOHANNA POON OD A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:POON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-209-6808
Mailing Address - Street 1:1391 WOODSIDE RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3578
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1391 WOODSIDE RD
Practice Address - Street 2:SUITE 218
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3578
Practice Address - Country:US
Practice Address - Phone:408-209-6808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service