Provider Demographics
NPI:1225176993
Name:KENNY, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:KENNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 153RD ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4051
Mailing Address - Country:US
Mailing Address - Phone:425-316-0338
Mailing Address - Fax:425-316-1993
Practice Address - Street 1:1025 153RD ST SE
Practice Address - Street 2:SUITE 100
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-4051
Practice Address - Country:US
Practice Address - Phone:425-316-0338
Practice Address - Fax:425-316-1993
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042763207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0197248OtherL & I
WA8440638Medicaid
WAI35532Medicare UPIN
WA8440638Medicaid