Basic Information
| Provider Information | |||||||||
| NPI: | 1902136013 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDNEY AND INTERNAL MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1561 W 7000 S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WEST JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840843556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013522700 | ||||||||
| FaxNumber: | 8013520400 | ||||||||
| Practice Location | |||||||||
| Address1: | 1561 W 7000 S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WEST JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840843556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015427115 | ||||||||
| FaxNumber: | 8013520400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2010 | ||||||||
| LastUpdateDate: | 01/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | JUNEJO | ||||||||
| AuthorizedOfficialFirstName: | NAZIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8015427115 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 51624871205 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.