Healthcare Provider Details

I. General information

NPI: 1760907505
Provider Name (Legal Business Name): SANDEEP KUNWAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2017
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NW 11TH ST STE M103
HERMISTON OR
97838-6941
US

IV. Provider business mailing address

620 NW 11TH ST STE M103
HERMISTON OR
97838-6941
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-5305
  • Fax: 541-303-8767
Mailing address:
  • Phone: 541-289-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD209911
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD209911
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: