MEDICARE: KARIS YE JIN COOPER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1316886831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIS YE JIN COOPER

Provider Business Mailing Address
First Line	:	2427 W WILLAMETTE AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-2660
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1465 KELLY JOHNSON BLVD STE 330
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3983
Country	:	US
Telephone Number	:	719-362-0796
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2026
Last Update Date	:	03/27/2026

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