Provider Demographics
NPI:1891704227
Name:TJANDRA, SARIKUN (MD)
Entity Type:Individual
Prefix:DR
First Name:SARIKUN
Middle Name:
Last Name:TJANDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 ROGERS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4022
Mailing Address - Country:US
Mailing Address - Phone:479-314-4600
Mailing Address - Fax:479-314-3630
Practice Address - Street 1:7001 ROGERS AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4022
Practice Address - Country:US
Practice Address - Phone:479-314-4600
Practice Address - Fax:479-314-3630
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3340207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146689001Medicaid
OK100224840AMedicaid
H45293Medicare UPIN
AR146689001Medicaid