Provider Demographics
NPI:1629774625
Name:HAIR BY KENNY SALON
Entity Type:Organization
Organization Name:HAIR BY KENNY SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-452-3837
Mailing Address - Street 1:7643 PINEVILLE MATTHEWS RD # 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3909
Mailing Address - Country:US
Mailing Address - Phone:904-452-3837
Mailing Address - Fax:
Practice Address - Street 1:7643 PINEVILLE MATTHEWS RD # 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3909
Practice Address - Country:US
Practice Address - Phone:904-452-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies