Individual provider Active NPI

Andrew T. Kuninobu, MD

  • Family Medicine Physician
  • San Diego, CA
National Provider Identifier
1548318538
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G80883 Issued in CA
Practice address
4647 Zion Ave
San Diego, CA 92120-2507
Phone
(619) 528-5000
NPI assigned
Jan 8, 2007
Last updated
Sep 23, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G80883 CA Primary

Addresses

Primary practice location

4647 Zion Ave
San Diego, CA 92120-2507

Mailing address

4647 Zion Ave
San Diego, CA 92120-2507
Phone (619) 528-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100713000365 CA Practitioner - Family Practice 2466584305 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Newstart Medical Group IncGroup PAC ID 8628299799, 22 clinicians

Practice addresses (Care Compare)

20601 W Paoli LN
Weimar, CA 95736-0486
Phone (530) 637-4025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
80883CAMDPharmacotherapy Pharmacist
G80883CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Newstart Medical Group Inc CurrentSince Jul 1, 2016 Accepting new patients

Locations

20601 Paoli Ln
Colfax, CA 95713
Phone (530) 637-4025

Interoperability endpoints

  • Direct secure messaging: andrew.kuninobu.1@11511.direct.athenahealth.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1548318538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4647 ZION AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921202507",
            "telephone_number": "619-528-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4647 ZION AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921202507",
            "telephone_number": "619-528-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNINOBU",
        "first_name": "ANDREW",
        "middle_name": "T.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G80883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.