Provider Demographics
NPI:1396746905
Name:HUNT, KENNETH I (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:I
Last Name:HUNT
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 1:1006 N H ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2535
Mailing Address - Country:US
Mailing Address - Phone:360-537-6391
Mailing Address - Fax:360-537-6322
Practice Address - Street 1:1006 N H ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-2535
Practice Address - Country:US
Practice Address - Phone:360-537-6391
Practice Address - Fax:360-537-6322
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2008-03-17
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
WAMD00012628207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0190562OtherL&I
WA1115286Medicaid
WA1163HUOtherCOUNTY INS
WA0190562OtherL&I
WAAB26537Medicare ID - Type UnspecifiedPERFORMING