Provider Demographics
NPI:1962694463
Name:KEVIN KUNZ MD, LLC
Entity type:Organization
Organization Name:KEVIN KUNZ MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-327-4848
Mailing Address - Street 1:75-170 HUALALAI ROAD
Mailing Address - Street 2:SUITE B103
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3211
Mailing Address - Country:US
Mailing Address - Phone:808-327-4848
Mailing Address - Fax:
Practice Address - Street 1:75-170 HUALALAI ROAD
Practice Address - Street 2:SUITE B103
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3211
Practice Address - Country:US
Practice Address - Phone:808-327-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-4036208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI552465Medicaid
C97463Medicare UPIN
HIH56676Medicare PIN