Koichi Shun Kunitake

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

118976 Issued in CA

Practice address

1145 Sturgis Rd
Twentynine Palms, CA 92278

Phone

(760) 830-2722

NPI assigned

Jul 10, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721952000000",
    "number": "1689837510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3525 DEL MAR HEIGHTS RD # 1987",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921302199",
            "telephone_number": "858-245-2353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 STURGIS RD",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "92278",
            "telephone_number": "760-830-2722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNITAKE",
        "first_name": "KOICHI",
        "middle_name": "SHUN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-10",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "118976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Knox, LMFT
• Taras Josaphat Konrad, DMD
• Anastasia Kostrubala, M.D.
• Jennifer Johanne Kozlowski, MSPT
• Todd Kramer, M.D.
• Urian Kyung
• Jennifer Anne Langley, M.A.
• Michael Lanker, D.O.
• Marilyn J Lantz, COTA
• Bruce R Laverty, MD

• Emergency Medicine Physician in Twentynine Palms, CA
• Providers in Twentynine Palms, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.