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Organization
JACK KENNIS MD INC
Active
Organization
JACK KENNIS MD INC
Active
Other names
jack kennis, jack kennis
Organization subpart
No
Provider details
NPI number
Authorized official
JACK KENNIS MD (CEO)
(714) 692-0800
Entity
Organization
Contact information
Practice address
27080 BIG HORN MOUNTAIN WAY, YORBA LINDA, CA 92887-4210
(714) 692-0800
Mailing address
27080 BIG HORN MOUNTAIN WAY, YORBA LINDA, CA 92887-4210
(714) 692-0800
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477504249
NPI
CA
Enumeration date
01/29/2025
Last updated
02/13/2025
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