Provider Demographics
NPI:1326031949
Name:KANO, JANE S
Entity Type:Individual
Prefix:PROF
First Name:JANE
Middle Name:S
Last Name:KANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:KIMIKO
Other - Last Name:SUEKAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1255 19TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1459
Mailing Address - Country:US
Mailing Address - Phone:303-861-4855
Mailing Address - Fax:303-861-2484
Practice Address - Street 1:1255 19TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1459
Practice Address - Country:US
Practice Address - Phone:303-861-4855
Practice Address - Fax:303-861-2484
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25648208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01256486Medicaid
CO01256486Medicaid
COC47611Medicare PIN