Healthcare Provider Details

I. General information

NPI: 1417937541
Provider Name (Legal Business Name): JAMES RICHARD KUNKEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 OAK PARK BLVD SUITE 103
ARROYO GRANDE CA
93420
US

IV. Provider business mailing address

880 OAK PARK BLVD SUITE 103
ARROYO GRANDE CA
93420
US

V. Phone/Fax

Practice location:
  • Phone: 805-474-9550
  • Fax: 805-474-9552
Mailing address:
  • Phone: 805-474-9550
  • Fax: 805-474-9552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG74608
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG74608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: