Healthcare Provider Details

I. General information

NPI: 1396189486
Provider Name (Legal Business Name): PHAYVANH PECHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PHAYVANH SJOGREN MD

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4090 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-7815
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberDR.0077149
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number61164
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: