Provider Demographics
NPI:1073784146
Name:KENNETH I HUNT
Entity Type:Organization
Organization Name:KENNETH I HUNT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:I
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-537-6391
Mailing Address - Street 1:1006 N H ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2521
Mailing Address - Country:US
Mailing Address - Phone:360-537-6391
Mailing Address - Fax:360-537-6322
Practice Address - Street 1:1006 N H ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-2521
Practice Address - Country:US
Practice Address - Phone:360-537-6391
Practice Address - Fax:360-537-6322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNETH I HUNT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012628207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0190562OtherL&I
WA1115286Medicaid
WAGAB26536OtherMEDICARE BILLING
WAGAB26537OtherMEDICARE PERFORMING
WA1163HUOtherCOUNTY INS
WA1163HUOtherCOUNTY INS