Healthcare Provider Details

I. General information

NPI: 1366454423
Provider Name (Legal Business Name): JULIE RENEE KENNER M.D., PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 05/24/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 PIERCE ST
MONTEREY CA
93940-2621
US

IV. Provider business mailing address

502 PIERCE ST
MONTEREY CA
93940-2621
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-3233
  • Fax:
Mailing address:
  • Phone: 831-747-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number10836
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG86681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: