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General NPI Number Information
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NPI Number | 1164583092
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Entity Type | Individual
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Provider Name | SEAN M. KENNEDY PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 39400 PASEO PADRE PKWY SURGERY DEPT - EMBARCADERO BLDG
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City | FREMONT
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State | CA
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Zip | 94538-2310
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Country | US
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Telephone | 510-248-3075
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Fax | 510-248-3364
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Provider Business Mailing Address
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Address Line | 39400 PASEO PADRE PKWY SURGERY DEPT - EMBARCADERO BLDG
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City | FREMONT
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State | CA
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Zip | 94538-2310
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Country | US
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Telephone | 510-248-3075
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Fax | 510-248-3364
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA16076
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License Number State | CA
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