Healthcare Provider Details

I. General information

NPI: 1609888429
Provider Name (Legal Business Name): STEPHANUS JOSEPH TJAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 E ORCHARD RD STE 203
LITTLETON CO
80121-8057
US

IV. Provider business mailing address

191 E ORCHARD RD STE 203
LITTLETON CO
80121-8057
US

V. Phone/Fax

Practice location:
  • Phone: 303-459-2150
  • Fax: 855-751-4155
Mailing address:
  • Phone: 303-459-2150
  • Fax: 855-751-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49802
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: