Individual
MR. JOHN A KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCO
Contact information
Practice address
150 EL CAMINO REAL, SUITE 101, TUSTIN, CA 92780-3668
(714) 508-8565
(714) 730-1894
Mailing address
150 EL CAMINO REAL, SUITE 101, TUSTIN, CA 92780-3668
(714) 508-8565
(714) 730-1894
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DXX00009F
—
CA
Enumeration date
03/07/2007
Last updated
08/01/2013
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