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General NPI Number Information
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NPI Number | 1811301898
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Entity Type | Individual
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Provider Name | JACQUELINE ELYCE KENNEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 2101 NORTH HILLHURST AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-2003
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Country | US
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Telephone | 323-664-2931
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Fax | 323-664-8931
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Provider Business Mailing Address
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Address Line | 2101 NORTH HILLHURST AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-2003
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Country | US
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Telephone | 323-664-2931
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Fax | 323-664-8931
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 51586
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License Number State | CA
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