Healthcare Provider Details

I. General information

NPI: 1104413558
Provider Name (Legal Business Name): IRIS KANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 PURCELL ST
BRIGHTON CO
80601-3551
US

IV. Provider business mailing address

2801 PURCELL ST
BRIGHTON CO
80601-3551
US

V. Phone/Fax

Practice location:
  • Phone: 303-659-9700
  • Fax:
Mailing address:
  • Phone: 303-659-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN.0109254
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995296-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: