Provider Demographics
NPI:1558725655
Name:KENNEDY, KENYA HERMENIA
Entity type:Individual
Prefix:
First Name:KENYA
Middle Name:HERMENIA
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 LOMA ALTA AVE BLDG 7
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6227
Mailing Address - Country:US
Mailing Address - Phone:408-425-4369
Mailing Address - Fax:408-335-1928
Practice Address - Street 1:499 LOMA ALTA AVE BLDG 7
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6227
Practice Address - Country:US
Practice Address - Phone:408-425-4369
Practice Address - Fax:408-335-1928
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101Y00000XOtherWORK UNITY CARE GROUP INC