Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD4036 | HI |
N | 208D00000X | General Practice Physician | MD-4036 | HI |
NPI | 1154356160 |
---|---|
Provider Name | Kevin Kunz |
First Address | Kealakekua, HI 96750-1277 |
Second Address | Kailua Kona, HI 96740-1705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 25/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
49067001 | (05) | HI |
490673 | (05) | HI |
C97463 | (02) |