Healthcare Provider Details

I. General information

NPI: 1073421632
Provider Name (Legal Business Name): HAGIE JHONG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6880 E EVANS AVE
DENVER CO
80224-2330
US

IV. Provider business mailing address

5253 S HANNIBAL WAY
CENTENNIAL CO
80015-4266
US

V. Phone/Fax

Practice location:
  • Phone: 720-386-8000
  • Fax:
Mailing address:
  • Phone: 720-276-5543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPN.1001871-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: