Individual
KATHLEEN MOIRA MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G67306
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G673060
—
CA
01
—
300121871
RAILROAD MEDICARE
CA
Enumeration date
06/21/2006
Last updated
03/19/2021
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