Healthcare Provider Details

I. General information

NPI: 1811943186
Provider Name (Legal Business Name): TIK L TJOA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 WEST POMONA BLVD
PONOMA CA
91769-0100
US

IV. Provider business mailing address

1600 9TH ST ROOM 205 MAILSTOP 2-3
SACRAMENTO CA
95814-6414
US

V. Phone/Fax

Practice location:
  • Phone: 909-595-1221
  • Fax:
Mailing address:
  • Phone: 916-654-2431
  • Fax: 916-654-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA29682
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA29682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: