Healthcare Provider Details

I. General information

NPI: 1326381195
Provider Name (Legal Business Name): JACOB P KUNES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2013
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

375 REDONDO AVE STE 570
LONG BEACH CA
90814-8130
US

V. Phone/Fax

Practice location:
  • Phone: 630-824-7801
  • Fax: 714-919-0163
Mailing address:
  • Phone: 630-824-7801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A14662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: