Healthcare Provider Details

I. General information

NPI: 1942403902
Provider Name (Legal Business Name): BRYAN PATRICK KONO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 18TH ST STE. 100
DENVER CO
80211
US

IV. Provider business mailing address

2650 18TH ST STE. 100
DENVER CO
80211
US

V. Phone/Fax

Practice location:
  • Phone: 720-583-4470
  • Fax: 888-463-5887
Mailing address:
  • Phone: 720-583-4470
  • Fax: 888-463-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA92091
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45399
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: