Provider Demographics
NPI:1194948026
Name:BOULDER VALLEY EAR NOSE & THROAT ASSOCIATES PC
Entity type:Organization
Organization Name:BOULDER VALLEY EAR NOSE & THROAT ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUN YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:MONKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-443-2771
Mailing Address - Street 1:4745 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1080
Mailing Address - Country:US
Mailing Address - Phone:303-443-2771
Mailing Address - Fax:303-443-2784
Practice Address - Street 1:4745 ARAPAHOE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1080
Practice Address - Country:US
Practice Address - Phone:303-443-2771
Practice Address - Fax:303-443-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty