Provider Demographics
NPI:1952878753
Name:KDDN, LLC
Entity Type:Organization
Organization Name:KDDN, LLC
Other - Org Name:DENVER VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-777-8346
Mailing Address - Street 1:2696 S COLORADO BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5963
Mailing Address - Country:US
Mailing Address - Phone:303-777-8346
Mailing Address - Fax:303-777-8377
Practice Address - Street 1:2696 S COLORADO BLVD STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5963
Practice Address - Country:US
Practice Address - Phone:303-777-8346
Practice Address - Fax:303-777-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO736361Medicaid