=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841165073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JNK ANESTHESIA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2025
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2509 NEUBAUER CIR
-----------------------------------------------------
City | LINDENHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60046-8783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-903-1152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2509 NEUBAUER CIR
-----------------------------------------------------
City | LINDENHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60046-8783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-903-1152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST ANESTHESIOLOGIST
-----------------------------------------------------
Name | JAMES KUNZLER
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 330-903-1152
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223D0004X
-----------------------------------------------------
Taxonomy Name | Dental Anesthesiology
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------