Provider Demographics
NPI:1770706665
Name:KINNANE, DENNIS GEORGE (OMD, LAC, RPH)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:GEORGE
Last Name:KINNANE
Suffix:
Gender:M
Credentials:OMD, LAC, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 PACIFIC COAST HIGHWAY,
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-373-9739
Mailing Address - Fax:
Practice Address - Street 1:4015 PACIFIC COAST HIGHWAY,
Practice Address - Street 2:SUITE 104
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-373-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3364171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist