Individual
DR. KEVIN S KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1818 SO UNION AVE, #2-C, TACOMA, WA 98405-1953
(253) 627-7567
(253) 627-4778
Mailing address
1818 SO UNION AVE, #2-C, TACOMA, WA 98405-1953
(253) 627-7567
(253) 627-4778
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
OP00001295
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1072040
—
WA
01
—
72498
DEPT OF LABOR & INDUSTRY
WA
01
—
KE4773
REGENCE BLUE SHIELD
WA
Enumeration date
07/17/2006
Last updated
07/20/2007
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