Basic Information
| Provider Information | |||||||||
| NPI: | 1891776191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUNISAKI | ||||||||
| FirstName: | SHAUN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9910 FRANKLIN SQUARE DR STE 2110 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212364902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109336423 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1800 ORLEANS ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212870010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109556256 | ||||||||
| FaxNumber: | 4105025314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 01/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 217767 | MA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 4301092951 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0120X | 4301092951 | MI | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | D86445 | MD | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
No ID Information.