Provider Demographics
NPI:1487099685
Name:KC, MANDIP (MD)
Entity type:Individual
Prefix:
First Name:MANDIP
Middle Name:
Last Name:KC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 AMBROSIA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3888
Mailing Address - Country:US
Mailing Address - Phone:303-788-8888
Mailing Address - Fax:844-347-5158
Practice Address - Street 1:3911 AMBROSIA ST STE 201
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3888
Practice Address - Country:US
Practice Address - Phone:303-788-8888
Practice Address - Fax:844-347-5158
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60475207R00000X
390200000X
CODR.0068727207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty