Healthcare Provider Details

I. General information

NPI: 1023503992
Provider Name (Legal Business Name): KEVIN LEE JUNUS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 ROWLAND WAY
NOVATO CA
94945-5009
US

IV. Provider business mailing address

PO BOX 6102
NOVATO CA
94948-6102
US

V. Phone/Fax

Practice location:
  • Phone: 415-209-1507
  • Fax:
Mailing address:
  • Phone: 415-884-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A17816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: