Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 35051267 | OH |
NPI | 1356391726 |
---|---|
Provider Name | Dr. Brian Kenney |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 14/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2470679 | (05) | OH |
G93111 | (02) |