Basic Information
| Provider Information | |||||||||
| NPI: | 1962694463 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEVIN KUNZ MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75-170 HUALALAI ROAD | ||||||||
| Address2: | SUITE B103 | ||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967403211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083274848 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75-170 HUALALAI ROAD | ||||||||
| Address2: | SUITE B103 | ||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967403211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083274848 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2007 | ||||||||
| LastUpdateDate: | 03/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | KUNZ | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8083274848 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | MD-4036 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 552465 | 05 | HI | MEDICAID |