Individual
DR. CHARLES DERENSBOUGH KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
229 SYCAMORE GROVE ST, SIMI VALLEY, CA 93065-7342
(805) 217-6724
(805) 217-6724
Mailing address
229 SYCAMORE GROVE ST, SIMI VALLEY, CA 93065-7342
(805) 217-6724
(805) 217-6724
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G066894
CA
Other
Enumeration date
03/31/2012
Last updated
03/31/2012
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