John Stephen Kundrat, MD PA

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

M3432 Issued in ID

Practice address

3316 Fourth Street
Lewiston, ID 83501-4405

Phone

(208) 746-0458

Fax

(208) 743-6020

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355875200000",
    "number": "1063589133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3316 FOURTH STREET",
            "address_2": "BLDG 3",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014405",
            "telephone_number": "208-746-0458",
            "fax_number": "208-743-6020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3316 FOURTH STREET",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014405",
            "telephone_number": "208-746-0458",
            "fax_number": "208-743-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNDRAT",
        "first_name": "JOHN",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "MD PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2012-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "M3432",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "MD00014874",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002460100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "1478601",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristy Kuehfuss, PHD, PLLC
• Stephen K Kronholm, MD
• Kimberly Ann Krueger
• Kristy Anne Kuehfuss, PH.D.
• Ajith J Kumar, MD
• Suriya Subashini Kunnukutty Mohan
• Gerald Thomas Kurdy, LMSW
• Paul Kwon, PH.D.
• Kym Orthopedics PLLC
• Christie Kytonen, LPN

• Ophthalmology Physician in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Ophthalmology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.