Healthcare Provider Details

I. General information

NPI: 1205017720
Provider Name (Legal Business Name): CHRISTY TRAN KLEINKE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W SOUTH BOULDER RD SUITE 110
LAFAYETTE CO
80026-2752
US

IV. Provider business mailing address

5450 WESTERN AVE
BOULDER CO
80301-2709
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-4355
  • Fax: 303-666-1982
Mailing address:
  • Phone: 303-415-4355
  • Fax: 303-666-1982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0057380
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: