Provider Demographics
NPI:1265098651
Name:VAN KENNEN, JAMES III
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:VAN KENNEN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MILL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:207-329-5242
Mailing Address - Fax:
Practice Address - Street 1:150 15TH ST
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2735
Practice Address - Country:US
Practice Address - Phone:207-329-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist