Provider Demographics
NPI:1679661896
Name:JAMES R KUNKEL,M.D.,INC
Entity Type:Organization
Organization Name:JAMES R KUNKEL,M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETTEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMBRONERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-474-9550
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:93420-1821
Mailing Address - Country:US
Mailing Address - Phone:805-474-9550
Mailing Address - Fax:
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:93420-1821
Practice Address - Country:US
Practice Address - Phone:805-474-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20072Medicare PIN