Healthcare Provider Details

I. General information

NPI: 1073956322
Provider Name (Legal Business Name): KIRAN CHANDRAKANT PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S PINE ST
TACOMA WA
98409-7264
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 253-476-6500
  • Fax: 253-476-6547
Mailing address:
  • Phone: 303-338-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number63985-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0059086
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: