Provider Demographics
NPI:1366454423
Name:KENNER, JULIE RENEE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:RENEE
Last Name:KENNER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2621
Mailing Address - Country:US
Mailing Address - Phone:831-747-1889
Mailing Address - Fax:
Practice Address - Street 1:502 PIERCE ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2621
Practice Address - Country:US
Practice Address - Phone:808-263-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10836207N00000X
CAG86681207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG86681OtherCALIFORNIA LICENSE
1366454423OtherNPI
CA207N00000XOther207N00000X
HIH30648Medicare UPIN
HI50825202Medicaid