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General NPI Number Information
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NPI Number | 1104007939
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Entity Type | Individual
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Provider Name | KARL FREDERICK KUNDERT JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 450 NW GILMAN BLVD SUITE 205
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City | ISSAQUAH
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State | WA
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Zip | 98027-2483
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Country | US
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Telephone | 425-391-3737
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Fax | 425-392-1510
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Provider Business Mailing Address
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Address Line | 710 THRASHER AVE NE
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City | NORTH BEND
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State | WA
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Zip | 98045-7919
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Country | US
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Telephone | 425-831-2227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10003011
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License Number State | WA
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