Provider Demographics
NPI:1215003843
Name:VON GUNTEN, CHARLES F (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:VON GUNTEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 MIDDLESEX DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2139
Mailing Address - Country:US
Mailing Address - Phone:619-607-9564
Mailing Address - Fax:
Practice Address - Street 1:4314 MIDDLESEX DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2139
Practice Address - Country:US
Practice Address - Phone:619-607-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85243207RH0002X
OH35120813207RX0202X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0081409Medicaid
CA00G852430Medicaid
OHPENDINGMedicare PIN
CA00G852430Medicaid
F59836Medicare UPIN