Provider Demographics
NPI:1427039908
Name:VANDERVEEN, KIMBERLY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:VANDERVEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 N OGDEN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3667
Mailing Address - Country:US
Mailing Address - Phone:303-812-6850
Mailing Address - Fax:303-812-6859
Practice Address - Street 1:1960 N OGDEN ST STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3667
Practice Address - Country:US
Practice Address - Phone:303-812-6850
Practice Address - Fax:303-812-6859
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2009-0509208600000X
CAA82127208600000X
KS04-56656208600000X
AZ67746208600000X
NE34980208600000X
TXT9325208600000X
WY14713C208600000X
MN513012086X0206X
390200000X
CO47730208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64633764Medicaid
MN910000013Medicare PIN
CARES000Medicare UPIN