Provider Demographics
NPI:1326458373
Name:MCHENRY, KATHRYN DANIELLE (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DANIELLE
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-1593
Mailing Address - Country:US
Mailing Address - Phone:909-376-1870
Mailing Address - Fax:
Practice Address - Street 1:1900 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3962
Practice Address - Country:US
Practice Address - Phone:714-967-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine