Healthcare Provider Details

I. General information

NPI: 1801890652
Provider Name (Legal Business Name): KIM W JUNDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 S MARION RD
SIOUX FALLS SD
57106-3646
US

IV. Provider business mailing address

1200 S 7TH AVE
SIOUX FALLS SD
57105-0900
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-5180
  • Fax: 605-322-5179
Mailing address:
  • Phone: 605-504-5400
  • Fax: 605-504-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4194
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: