Healthcare Provider Details

I. General information

NPI: 1700802295
Provider Name (Legal Business Name): RANDALL AARON GOLDSTEIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RANDALL AARON GOLDSTEIN DO

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 E KANSAS CITY RD
OLATHE KS
66061-7050
US

IV. Provider business mailing address

2111 E KANSAS CITY RD
OLATHE KS
66061-7050
US

V. Phone/Fax

Practice location:
  • Phone: 913-220-5724
  • Fax: 913-222-1907
Mailing address:
  • Phone: 913-220-5724
  • Fax: 913-222-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29058
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: