Provider Demographics
NPI:1104007939
Name:KUNDERT, KARL FREDERICK JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:FREDERICK
Last Name:KUNDERT
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 THRASHER AVE NE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-7919
Mailing Address - Country:US
Mailing Address - Phone:425-831-2227
Mailing Address - Fax:
Practice Address - Street 1:450 NW GILMAN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2483
Practice Address - Country:US
Practice Address - Phone:425-391-3737
Practice Address - Fax:425-392-1510
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003011363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP90050Medicare UPIN
WAGAB37596Medicare PIN