Healthcare Provider Details

I. General information

NPI: 1407241011
Provider Name (Legal Business Name): PRIYA DOKKEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 GUNPARK DR STE 320
BOULDER CO
80301-3346
US

IV. Provider business mailing address

6525 GUNPARK DR STE 320
BOULDER CO
80301-3346
US

V. Phone/Fax

Practice location:
  • Phone: 720-649-6337
  • Fax:
Mailing address:
  • Phone: 720-649-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0060840
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: