Healthcare Provider Details

I. General information

NPI: 1972707230
Provider Name (Legal Business Name): JOY DEANN KENNEDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6386 ALVARADO CT STE 210
SAN DIEGO CA
92120-4907
US

IV. Provider business mailing address

6386 ALVARADO CT STE 210
SAN DIEGO CA
92120-4907
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone: 858-279-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA124885
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA124885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: