Healthcare Provider Details

I. General information

NPI: 1518405596
Provider Name (Legal Business Name): AMY KHONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 FOREST ST SUITE E
DENVER CO
80216
US

IV. Provider business mailing address

4770 FOREST ST SUITE E
DENVER CO
80216
US

V. Phone/Fax

Practice location:
  • Phone: 303-680-7337
  • Fax: 303-680-7337
Mailing address:
  • Phone: 303-680-7337
  • Fax: 303-680-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: