1275647414 NPI number — DR. LAWRENCE KIM M.D

Table of content: DR. LAWRENCE KIM M.D (NPI 1275647414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275647414 NPI number — DR. LAWRENCE KIM M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
LAWRENCE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIM
Provider Other First Name:
LAWRENCE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275647414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10103 RIDGE GATE PARKWAY
Provider Second Line Business Mailing Address:
STE 312
Provider Business Mailing Address City Name:
LONE TREE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-788-8888
Provider Business Mailing Address Fax Number:
866-456-4594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10103 RIDGEGATE PKWY
Provider Second Line Business Practice Location Address:
STE 312
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-5520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-788-8888
Provider Business Practice Location Address Fax Number:
866-456-4594
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  36975 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100012740 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01369750 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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