Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A117899 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A117899 | CA |
NPI | 1083933535 |
---|---|
Provider Name | Gannon Daniel Kennedy |
First Address | Redwood City, CA 94063-1567 |
Second Address | Redwood City, CA 94063-1567 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2010 |
Last Update Date | 04/01/2022 |