Individual
DR. JOHN STEPHEN KUNDRAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PA
Contact information
Practice address
3316 FOURTH STREET, LEWISTON, ID 83501-4405
(208) 746-0458
(208) 743-6020
Mailing address
3316 FOURTH STREET, BLDG 3, LEWISTON, ID 83501-4405
(208) 746-0458
(208) 743-6020
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M3432
ID
207W00000X
Ophthalmology Physician
MD00014874
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002460100
—
ID
01
—
1478601
MEDICAID
WA
Enumeration date
11/30/2006
Last updated
12/19/2012
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