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Kellen James Glynn, MD
General Practice Physician in Twentynine Palms, California
NPI 1598359713

Kellen James Glynn is a General Practice Physician based in Twentynine Palms, CA. Kellen James Glynn practices in Twentynine Palms, CA and has the professional credentials of MD. The NPI Number for Kellen James Glynn is 1598359713 and holds a License No. 0101276029 (California).

The current practice location address for Kellen James Glynn is 1546 6Th Street, Twentynine Palms, CA and can be reached out via phone at 760-830-2621.

Location: 1546 6Th Street, Twentynine Palms, CA, 92277
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1598359713
Provider Name
Kellen James Glynn
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
1546 6Th Street, Twentynine Palms, CA, 92277
Phone Number
760-830-2621
Fax Number
Provider Enumeration Date
02/28/2021
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
S069-130-009-815 01 MN DRIVER'S LICENSE
institution
Provider Business Practice Location Address Details
Address
1546 6Th Street
City
Twentynine Palms
State
California
Zip
92277
Phone Number
760-830-2621
Fax Number
person
Provider Business Mailing Address Details
Address
1546 6Th Street
City
Twentynine Palms
State
California
Zip
92277
Phone Number
760-830-2621
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
171000000X
License No.
0101276029 (Virginia)
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
0101276029 (Virginia)
Definition
Definition to come...
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