Basic Information
| Provider Information | |||||||||
| NPI: | 1154356160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUNZ | ||||||||
| FirstName: | KEVIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1277 | ||||||||
| Address2: | |||||||||
| City: | KEALAKEKUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967501277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083274848 | ||||||||
| FaxNumber: | 8083274803 | ||||||||
| Practice Location | |||||||||
| Address1: | 75-5751 KUAKINI HWY STE 101A | ||||||||
| Address2: | |||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083265629 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 02/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | MD-4036 | HI | N | Allopathic & Osteopathic Physicians | General Practice | 207QA0401X | MD4036 | HI | Y | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
ID Information
| ID | Type | State | Issuer | Description | 49067001 | 05 | HI | MEDICAID | 490673 | 05 | HI | MEDICAID |