Basic Information
| Provider Information | |||||||||
| NPI: | 1447372420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAN | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS, PT, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12600 W COLFAX AVE STE B160 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802153754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032386880 | ||||||||
| FaxNumber: | 3032029412 | ||||||||
| Practice Location | |||||||||
| Address1: | 12600 W COLFAX AVE STE B160 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802153754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032386880 | ||||||||
| FaxNumber: | 3032029412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | HD968104 | CO | Y | Dental Providers | Dentist | General Practice |
No ID Information.