Healthcare Provider Details

I. General information

NPI: 1063562270
Provider Name (Legal Business Name): DONALD BENJAMIN KUNZER BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 SW 12TH AVE
PORTLAND OR
97205-2329
US

IV. Provider business mailing address

1316 SE 18TH AVE
PORTLAND OR
97214-3802
US

V. Phone/Fax

Practice location:
  • Phone: 503-228-7134
  • Fax: 503-944-2595
Mailing address:
  • Phone: 406-370-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: