Healthcare Provider Details

I. General information

NPI: 1508841321
Provider Name (Legal Business Name): THOMAS L. KUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 CLUB PL
LOS ANGELES CA
90064-3420
US

IV. Provider business mailing address

1301 20TH ST 376
SANTA MONICA CA
90404-2087
US

V. Phone/Fax

Practice location:
  • Phone: 310-738-1054
  • Fax:
Mailing address:
  • Phone: 310-829-6789
  • Fax: 310-935-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA23046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: