Provider Demographics
NPI:1487699641
Name:KENNEY, RICK D (DO)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:D
Last Name:KENNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 OLD NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4148
Mailing Address - Country:US
Mailing Address - Phone:949-650-2887
Mailing Address - Fax:949-642-1620
Practice Address - Street 1:355 PLACENTIA AVE
Practice Address - Street 2:STE 101
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3301
Practice Address - Country:US
Practice Address - Phone:949-612-7358
Practice Address - Fax:949-650-1902
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H19206Medicare UPIN