Provider Demographics
NPI:1720393846
Name:KIM, HANA ANGELA (DDS)
Entity type:Individual
Prefix:DR
First Name:HANA
Middle Name:ANGELA
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 S PEORIA ST STE A
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3182
Mailing Address - Country:US
Mailing Address - Phone:303-368-3636
Mailing Address - Fax:303-368-3631
Practice Address - Street 1:2900 S PEORIA ST STE A
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3182
Practice Address - Country:US
Practice Address - Phone:303-368-3636
Practice Address - Fax:303-368-3631
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA596461223G0001X
CO002029801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08155062Medicaid
CO1720393846Medicaid