Provider Demographics
NPI:1669171625
Name:HENNESSAY MEDICAL CORPORATION
Entity type:Organization
Organization Name:HENNESSAY MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:424-235-5235
Mailing Address - Street 1:2604 W 225TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2902
Mailing Address - Country:US
Mailing Address - Phone:310-365-8625
Mailing Address - Fax:424-447-8239
Practice Address - Street 1:3655 LOMITA BLVD STE 307
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-1922
Practice Address - Country:US
Practice Address - Phone:424-235-5235
Practice Address - Fax:949-404-6987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty