Provider Demographics
NPI:1376642488
Name:HAND, MIKYONG (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKYONG
Middle Name:
Last Name:HAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-4751
Mailing Address - Fax:303-415-4769
Practice Address - Street 1:1000 W SOUTH BOULDER RD STE 110
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2753
Practice Address - Country:US
Practice Address - Phone:303-415-4355
Practice Address - Fax:303-666-1982
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0042785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25005537Medicaid
COCOA101290Medicare PIN