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Individual
MR. RYAN MASARU KENNEDY
Active
Individual
MR. RYAN MASARU KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
55631
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55631
PHYSICIAN ASSISTANT BOARD
CA
Enumeration date
06/08/2018
Last updated
11/05/2018
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