1003444159 NPI number — HEIDI YEN HALLAM

Table of content: HEIDI YEN HALLAM (NPI 1003444159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003444159 NPI number — HEIDI YEN HALLAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALLAM
Provider First Name:
HEIDI
Provider Middle Name:
YEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YEN
Provider Other First Name:
HEIDI
Provider Other Middle Name:
LI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003444159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6810 E 132ND PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THORNTON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80602-8149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-318-3765
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14300 ORCHARD PKWY FL 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80023-9206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-430-5560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  DR.0067176 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QH0002X , with the licence number: DR.0067176 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9000183025 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".