Healthcare Provider Details

I. General information

NPI: 1275387342
Provider Name (Legal Business Name): MICHAEL-JEFFREY KENNEDY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL KENNEDY DMD

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26787 AGOURA RD
CALABASAS CA
91302-2973
US

IV. Provider business mailing address

1201 S HOPE ST APT 1706
LOS ANGELES CA
90015-4699
US

V. Phone/Fax

Practice location:
  • Phone: 818-878-7300
  • Fax:
Mailing address:
  • Phone: 213-800-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number110900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: