Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036-133280 | IL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | DR.0063648 | CO |
NPI | 1053578906 |
---|---|
Provider Name | Dr. Richard Won Kang |
First Address | Denver, CO 80247-1314 |
Second Address | Denver, CO 80205-5437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2008 |
Last Update Date | 06/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
029021 | KAISER COMMERCIAL NUMBER (01) | CO |