Healthcare Provider Details

I. General information

NPI: 1003444159
Provider Name (Legal Business Name): HEIDI YEN HALLAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI LI YEN MD

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 ORCHARD PKWY FL 1
WESTMINSTER CO
80023-9206
US

IV. Provider business mailing address

6810 E 132ND PL
THORNTON CO
80602-8149
US

V. Phone/Fax

Practice location:
  • Phone: 303-430-5560
  • Fax:
Mailing address:
  • Phone: 720-318-3765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0067176
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberDR.0067176
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: