Jack Kennis MD Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

JACK KENNIS MD INC

Practice address

27080 Big Horn Mountain Way
Yorba Linda, CA 92887-4210

Phone

(714) 692-0800

NPI assigned

Jan 29, 2025

Last updated

Feb 13, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jack Kennis, MDNPI 1477504249

Title

Ceo

Phone

(714) 692-0800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• jack kennis Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jack D Kennis, MD

  • Emergency Medicine Physician
  • Downey, CA
  • NPI 1477504249
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1033922497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27080 BIG HORN MOUNTAIN WAY",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928874210",
            "telephone_number": "714-692-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27080 BIG HORN MOUNTAIN WAY",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928874210",
            "telephone_number": "714-692-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK KENNIS MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-29",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "KENNIS",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-692-0800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1477504249",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "jack kennis",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "jack kennis",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "jack kennis",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nora Iskandar
• Briana Itzep
• Ana Ivanova, M.D.
• J Bradford Fisher MD Inc (Body By Fisher)
• J L Rosenthal MD Inc
• Manera Jeszel Jackson, RN
• Michelle Christine Jackson, MSW, LCSW
• Jaclyn W. Bae, DDS Inc (Jaclyn W. Bae, DDS Inc dba Sunshine Pediatric Dentistry)
• Lorraine Anne Jacob, SPEECH PATHOLOGIST
• Nicole Jahne, D.P.T.

• Internal Medicine Physician in Yorba Linda, CA
• Providers in Yorba Linda, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.