Healthcare Provider Details

I. General information

NPI: 1376634089
Provider Name (Legal Business Name): E. BARRIE KENNEY D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PLZ SUITE 320
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

929 MALCOLM AVE
LOS ANGELES CA
90024-3113
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6252
  • Fax:
Mailing address:
  • Phone: 310-474-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number28738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: