Individual
JACK D KENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11500 BROOKSHIRE AVE, DOWNEY, CA 90241
(562) 904-5000
Mailing address
PO BOX 39159, DOWNEY, CA 90239
(562) 809-3576
(562) 468-0347
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G46843
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G468430
—
CA
Enumeration date
05/15/2006
Last updated
01/29/2025
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