Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jasen Tjahjadi

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1649839077

Jasen Tjahjadi is a Family Practice in Brentwood, California. Graduated from Eastern Virginia Medical School in 2019, 7 years ago. Licensed in California and Pennsylvania.

Years since qualifying
7
Trained at
Eastern Virginia Medical School
Licensed in
CA, PA
In the registry since
2019
Specialties on file
2
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

171 Sand Creek Rd Ste A
Brentwood, CA 94513-2057
Phone: (717) 544-4940
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence A176433 (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence MT217899 (PA)

Record details

NPI number1649839077
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 10, 2019
Last updated in NPPESJune 18, 2026
Certification dateJune 18, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolEASTERN VIRGINIA MEDICAL SCHOOL
Graduated 2019 (7 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Brentwood