Provider Demographics
NPI:1376861906
Name:NEWGENE, KENNY (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNY
Middle Name:
Last Name:NEWGENE
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 1:8609 SOUTHWESTERN BLVD
Mailing Address - Street 2:623
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-2675
Mailing Address - Country:US
Mailing Address - Phone:318-655-3328
Mailing Address - Fax:
Practice Address - Street 1:8609 SOUTHWESTERN BLVD APT 623
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-8237
Practice Address - Country:US
Practice Address - Phone:318-655-3328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.41383207R00000X
OK28982208M00000X
TXQ2690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZS6VMedicare PIN