Provider Demographics
NPI:1366454423
Name:KENNER, JULIE RENEE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:RENEE
Last Name:KENNER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 ULUKAHIKI ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4400
Mailing Address - Country:US
Mailing Address - Phone:808-263-3233
Mailing Address - Fax:
Practice Address - Street 1:642 ULUKAHIKI ST STE 104
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4418
Practice Address - Country:US
Practice Address - Phone:808-263-3233
Practice Address - Fax:808-263-3220
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10836207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA0228708OtherHMSA PROVIDER NUMBER
HI50825202Medicaid
CAG86681OtherCALIFORNIA LICENSE
HIH30648Medicare UPIN
HI50825202Medicaid