Provider Demographics
NPI:1659455822
Name:KUNDELL, STEPHEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:KUNDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NEWBURY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6441
Mailing Address - Country:US
Mailing Address - Phone:805-480-3730
Mailing Address - Fax:805-480-1951
Practice Address - Street 1:1000 NEWBURY RD STE 200
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6441
Practice Address - Country:US
Practice Address - Phone:805-480-3730
Practice Address - Fax:805-480-1951
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG32875208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104435Medicaid