Provider Demographics
NPI:1982447363
Name:MAHANA, KELLY DUANE JR
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DUANE
Last Name:MAHANA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 14TH ST UNIT 909
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-3256
Mailing Address - Country:US
Mailing Address - Phone:720-766-9093
Mailing Address - Fax:
Practice Address - Street 1:3181 W 93RD AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2703
Practice Address - Country:US
Practice Address - Phone:720-766-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator