1215003736 NPI number — MR. GORDON JAY KIEFT M.DIV., M.A.

Table of content: MR. GORDON JAY KIEFT M.DIV., M.A. (NPI 1215003736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215003736 NPI number — MR. GORDON JAY KIEFT M.DIV., M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIEFT
Provider First Name:
GORDON
Provider Middle Name:
JAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.DIV., M.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIEFT
Provider Other First Name:
GORDON
Provider Other Middle Name:
JAY
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.DIV., M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215003736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9185 E KENYON AVE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80237-1822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-741-5588
Provider Business Mailing Address Fax Number:
303-756-7703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 E GIRARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80224-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-741-5588
Provider Business Practice Location Address Fax Number:
303-756-7703
Provider Enumeration Date:
11/27/2006

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: 101YM0800X , with the licence number:  LPC 430 , 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)





Copyright © 2007-2025 www.npivalidator.com