Healthcare Provider Details

I. General information

NPI: 1750649471
Provider Name (Legal Business Name): KATHRYN MORRIS GUNNISON M.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S 11TH ST
SAN JOSE CA
95112-2132
US

IV. Provider business mailing address

1530 THE ALAMEDA STE 301
SAN JOSE CA
95126-2303
US

V. Phone/Fax

Practice location:
  • Phone: 408-495-9471
  • Fax: 408-279-2841
Mailing address:
  • Phone: 914-374-2818
  • Fax: 408-982-5584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA124321
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA124321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: