Healthcare Provider Details

I. General information

NPI: 1619781911
Provider Name (Legal Business Name): KENNEALLY ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23542 LYONS AVE STE 202
NEWHALL CA
91321-5713
US

IV. Provider business mailing address

23542 LYONS AVE STE 202
NEWHALL CA
91321-5713
US

V. Phone/Fax

Practice location:
  • Phone: 661-252-4100
  • Fax:
Mailing address:
  • Phone: 818-383-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN ANN KENNEALLY
Title or Position: ACUPUNCTURIST/ OWNER
Credential: L.AC.
Phone: 661-252-4100