Healthcare Provider Details

I. General information

NPI: 1023375664
Provider Name (Legal Business Name): KARIN DEJONG VANBAAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARIN LYNN DEJONG M.D.

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5495 ARAPAHOE AVE
BOULDER CO
80303-1200
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number59604
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number59604
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number59604
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: