Provider Demographics
NPI:1881065274
Name:HUNT, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:HUNT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 LLOYD THAYER CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-5524
Mailing Address - Country:US
Mailing Address - Phone:734-890-8200
Mailing Address - Fax:
Practice Address - Street 1:5405 N PERSHING AVE
Practice Address - Street 2:SUITE C1
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5451
Practice Address - Country:US
Practice Address - Phone:209-476-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program