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General NPI Number Information
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NPI Number | 1689837510
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Entity Type | Individual
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Provider Name | KOICHI SHUN KUNITAKE
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Gender | Male
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 1145 STURGIS RD
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92278
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Country | US
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Telephone | 760-830-2722
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Fax |
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Provider Business Mailing Address
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Address Line | 3525 DEL MAR HEIGHTS RD # 1987
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City | SAN DIEGO
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State | CA
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Zip | 92130-2199
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Country | US
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Telephone | 858-245-2353
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 118976
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License Number State | CA
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