Provider Demographics
NPI:1417937541
Name:KUNKEL, JAMES RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:KUNKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:880 OAK PARK BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420
Mailing Address - Country:US
Mailing Address - Phone:805-474-9550
Mailing Address - Fax:805-474-9552
Practice Address - Street 1:880 OAK PARK BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-474-9550
Practice Address - Fax:805-474-9552
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74608207N00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D685938OtherCLIA
CABK3252955OtherDEA
CAWG74608AMedicare ID - Type Unspecified
G09568Medicare UPIN