Healthcare Provider Details

I. General information

NPI: 1184112351
Provider Name (Legal Business Name): JEREMY YICHEN FENG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10103 RIDGEGATE PKWY STE 103
LONE TREE CO
80124-5524
US

IV. Provider business mailing address

10103 RIDGEGATE PKWY STE 103
LONE TREE CO
80124-5524
US

V. Phone/Fax

Practice location:
  • Phone: 303-645-0090
  • Fax: 303-645-0092
Mailing address:
  • Phone: 303-645-0090
  • Fax: 303-645-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberCDR.0006973
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberCDR.0006973
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberCDR.0006973
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: