Provider Demographics
NPI:1265828776
Name:MAHONEY, KENDRA RAE (MD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:RAE
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20911 EARL ST STE 440
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4355
Mailing Address - Country:US
Mailing Address - Phone:562-688-2108
Mailing Address - Fax:562-203-8766
Practice Address - Street 1:20911 EARL ST STE 440
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4355
Practice Address - Country:US
Practice Address - Phone:310-419-8585
Practice Address - Fax:310-419-8583
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19137207V00000X
CAA184076207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology