Provider Demographics
NPI:1346377975
Name:BEN KUNDARIA MD INC
Entity Type:Organization
Organization Name:BEN KUNDARIA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GERGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-922-6616
Mailing Address - Street 1:1505 SHEPARD DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7016
Mailing Address - Country:US
Mailing Address - Phone:805-922-6616
Mailing Address - Fax:
Practice Address - Street 1:1505 SHEPARD DR STE 106
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7016
Practice Address - Country:US
Practice Address - Phone:805-922-6616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35703174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357030Medicaid
CAW1520Medicare PIN