Provider Demographics
NPI:1598984429
Name:MARTIN, KEN ALLEN (CSA)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:ALLEN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
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Mailing Address - Street 1:9850 FEDERAL BLVD LOT 105
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-5771
Mailing Address - Country:US
Mailing Address - Phone:303-469-2819
Mailing Address - Fax:303-469-5099
Practice Address - Street 1:9850 FEDERAL BLVD LOT 105
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-5771
Practice Address - Country:US
Practice Address - Phone:303-469-2819
Practice Address - Fax:303-469-5099
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist