Healthcare Provider Details

I. General information

NPI: 1053382085
Provider Name (Legal Business Name): ERIC JAMES KUNCIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CITY BLVD W SUITE 1600
ORANGE CA
92868-2903
US

IV. Provider business mailing address

7261 MERCY RD
OMAHA NE
68124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5890
  • Fax: 714-456-6048
Mailing address:
  • Phone: 402-398-6248
  • Fax: 402-829-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG072181
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberG072181
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG072181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: