Individual ProviderKenneth JohnsonEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address4445 Magnolia Ave, Riverside, CA 92501-4135(951) 788-3537(951) 235-7665PECOS EnrollmentBased on the most recent information from CMS, provider Kenneth Johnson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1033640933Provider TypeIndividualFull NameJohnson, KennethCredentialMDGenderMaleSole ProprietorYesEnumeration Date3/22/2017Last Updated12/19/2019Contact InformationPractice LocationPractice Address4445 Magnolia Ave, Riverside, CA 92501-4135Phone(951) 788-3537Fax(951) 788-3173Mailing LocationMailing Address9155 Santa Barbara Dr, Riverside, CA 92508-6496Phone(951) 235-7665FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicenseA159476California