Provider Demographics
NPI:1073788865
Name:KOZAN, HASAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:HASAN
Middle Name:
Last Name:KOZAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 TABLE MESA DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5869
Mailing Address - Country:US
Mailing Address - Phone:303-499-9395
Mailing Address - Fax:303-494-1462
Practice Address - Street 1:3400 TABLE MESA DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5869
Practice Address - Country:US
Practice Address - Phone:303-499-9395
Practice Address - Fax:303-494-1462
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1352171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist