IndividualActive
Lyndon Johansen, DPM
NPI 1306820402 · Podiatrist · Portland, OR
Provider details
- NPI number
- 1306820402
- Entity type
- Individual
- Primary specialty
- PodiatristPodiatric Medicine & Surgery Service Providers
- Credential
- DPM
- Sex
- Male
- Sole proprietor
- Yes
- License
- DP00230 (OR)
Specialties & taxonomies
Podiatric Medicine & Surgery Service Providers
Practice location
12658 Se Stark St
Portland, OR 97233-1058
Phone: (503) 256-4018
Fax: (503) 256-6298
Approximate (ZIP-level) locationGet directions
Mailing address
12658 Se Stark St
Portland, OR 97233-1058
Registry dates
- Enumerated
- 2005-12-01
- Last updated
- 2013-01-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.