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General NPI Number Information
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NPI Number | 1285723957
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Entity Type | Individual
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Provider Name | KYLE JOSEPH HENNEBERRY MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 16040 NE 153RD ST
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City | WOODINVILLE
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State | WA
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Zip | 98072-8903
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Country | US
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Telephone | 208-416-2932
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Fax | 855-673-9190
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Provider Business Mailing Address
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Address Line | 22100 BOTHELL EVERETT HWY
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City | BOTHELL
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State | WA
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Zip | 98021-8431
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Country | US
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Telephone | 208-416-2932
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Fax | 855-673-9190
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD00047394
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License Number State | WA
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