Healthcare Provider Details

I. General information

NPI: 1629482443
Provider Name (Legal Business Name): STEVEN KENNEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 02/11/2022
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10666 N TORREY PINES RD
LA JOLLA CA
92037-1027
US

IV. Provider business mailing address

26520 CACTUS AVE. ORTHOPEDICS DEPARTMENT
MORENO VALLEY CA
92555
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-7808
  • Fax: 858-554-6321
Mailing address:
  • Phone: 951-486-4552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: