MEDICARE: KILSAN KOH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	29339	CO
2	208600000X	Surgery Physician	G87774	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023114006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KILSAN KOH M.D.

Provider Business Mailing Address
First Line	:	1000 ALPINE AVE
Second Line	:	SUITE 210
City	:	BOULDER
State	:	CO
Zip	:	80304-3406
Country	:	US
Telephone Number	:	303-443-1008
Fax Number	:	303-417-1111

Provider Business Practice Location Address
First Line	:	1000 ALPINE AVE
Second Line	:	SUITE 210
City	:	BOULDER
State	:	CO
Zip	:	80304-3406
Country	:	US
Telephone Number	:	303-443-1008
Fax Number	:	303-417-1111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	12/15/2010

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Directions to “ KILSAN KOH M.D.” Practice Location

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