=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295845758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4720 RAINBOW BLVD KU DENTAL ASSOCIATES, STE. 250
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66205-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-588-9200
-----------------------------------------------------
Fax | 913-588-9203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2330 SHAWNEE MISSION PKWY MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE 312
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66205-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-588-9000
-----------------------------------------------------
Fax | 913-588-9822
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | E. CHRISTIAN HANSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-588-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------