Healthcare Provider Details

I. General information

NPI: 1396943940
Provider Name (Legal Business Name): COLORADO PEDIATRIC PULMONARY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 S UNIVERSITY BLVD SUITE 203
CENTENNIAL CO
80123
US

IV. Provider business mailing address

7960 S UNIVERSITY BLVD SUITE 203
CENTENNIAL CO
80123
US

V. Phone/Fax

Practice location:
  • Phone: 303-869-2120
  • Fax: 303-869-1950
Mailing address:
  • Phone: 303-869-2120
  • Fax: 303-869-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number32129
License Number StateCO

VIII. Authorized Official

Name: DR. TANIA Z KHAN
Title or Position: PEDIATRIC PULMONOLOGIST
Credential: M.D.
Phone: 303-869-2120