Healthcare Provider Details

I. General information

NPI: 1053245324
Provider Name (Legal Business Name): BETHANY PAJ TSIS THAWJ XIONG-KOON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANY PAJ TSIS THAWJ XIONG DO

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 23RD AVE
GREELEY CO
80634-6070
US

IV. Provider business mailing address

2639 W 104TH CT
WESTMINSTER CO
80234-3509
US

V. Phone/Fax

Practice location:
  • Phone: 303-929-3768
  • Fax:
Mailing address:
  • Phone: 303-929-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0011613
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: