Basic Information
| Provider Information | |||||||||
| NPI: | 1871502567 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3556 W 9800 S STE 101 | ||||||||
| Address2: | |||||||||
| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840953211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015679780 | ||||||||
| FaxNumber: | 8015679826 | ||||||||
| Practice Location | |||||||||
| Address1: | 3556 W 9800 S STE 101 | ||||||||
| Address2: | |||||||||
| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840953221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015679780 | ||||||||
| FaxNumber: | 8015679826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | 2747431205 | UT | Y | Other Service Providers | Legal Medicine |
No ID Information.