Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 53048 | MN |
N | 2084N0402X | Child Neurologist | 53048 | MN |
NPI | 1063644771 |
---|---|
Provider Name | Daniel L Kenney-Jung |
First Address | Minneapolis, MN 55454-1404 |
Second Address | Minneapolis, MN 55454-1404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2009 |
Last Update Date | 05/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |