1700920352 NPI number — PHYSICIANS MEDICAL MANAGEMENT PROFESSIONALS

Table of content: DR. BRANDON SANG JOON KANG MD (NPI 1871561803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700920352 NPI number — PHYSICIANS MEDICAL MANAGEMENT PROFESSIONALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS MEDICAL MANAGEMENT PROFESSIONALS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700920352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
290 NICKEL ST
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
BROOMFIELD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80020-2183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-460-9339
Provider Business Mailing Address Fax Number:
303-460-7443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 NICKEL ST
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
BROOMFIELD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80020-2183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-460-9339
Provider Business Practice Location Address Fax Number:
303-460-7443
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STEPAN
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
303-447-5522

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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