Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | LT000762 | PA |
NPI | 1225580038 |
---|---|
Provider Name | Uchenna Katharina Kennedy |
First Address | Philadelphia, PA 19103-1731 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2016 |
Last Update Date | 27/10/2016 |