Provider Demographics
NPI:1659541191
Name:HENDRICKS, KENNETH ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALLEN
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:NAVAL HEALTH CLINIC OAK HARBOR
Mailing Address - Street 2:3475 N SARATOGA ST
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98278-0001
Mailing Address - Country:US
Mailing Address - Phone:360-257-5106
Mailing Address - Fax:360-257-9878
Practice Address - Street 1:3475 N SARATOGA ST
Practice Address - Street 2:NAVAL HEALTH CLINIC
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98278-0001
Practice Address - Country:US
Practice Address - Phone:360-257-5106
Practice Address - Fax:360-257-9878
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2019-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102202300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine