Healthcare Provider Details

I. General information

NPI: 1881012722
Provider Name (Legal Business Name): JULIO TIAN-FA CHONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EXEMPLA CIR STE 250
LAFAYETTE CO
80026-3392
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 720-536-3011
  • Fax: 303-468-5117
Mailing address:
  • Phone: 443-738-2872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0086257
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberDR.0064844
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: