1467695916 NPI number — DR. EILEEN JACQUELINE KENNY DC

Table of content: DR. EILEEN JACQUELINE KENNY DC (NPI 1467695916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467695916 NPI number — DR. EILEEN JACQUELINE KENNY DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENNY
Provider First Name:
EILEEN
Provider Middle Name:
JACQUELINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NONE
Provider Other First Name:
NONE
Provider Other Middle Name:
NONE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NONE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467695916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1911 N. LAKE AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91001-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-398-0292
Provider Business Mailing Address Fax Number:
626-398-8776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1911 N. LAKE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91001-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-398-0292
Provider Business Practice Location Address Fax Number:
626-398-8776
Provider Enumeration Date:
04/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  17929 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)