Healthcare Provider Details

I. General information

NPI: 1528379708
Provider Name (Legal Business Name): KRISTOPHER VINCENT KUHL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIRCLE DAVID GRANT MEDICAL CENTER
FAIRFIELD CA
94535
US

IV. Provider business mailing address

101 BODIN CIRCLE TRAVIS AFB
FAIRFIELD CA
94535
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A15310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: