MEDICARE: WOUNDTECH OF UTAH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician
2	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11302963-1205	OTHER	UT	UTAH MEDICAL BOARD

General Provider Information

NPI Number	:	1750922415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUNDTECH OF UTAH, INC.

Provider Business Mailing Address
First Line	:	PO BOX 202389
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-2389
Country	:	US
Telephone Number	:	954-923-7440
Fax Number	:	954-923-1299

Provider Business Practice Location Address
First Line	:	517 D ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2831
Country	:	US
Telephone Number	:	954-923-7440
Fax Number	:	954-923-1299

Authorized Official
Title or Position	:	AUTHORIZED OFFICAIL
Name	:	MINGHSUN LIU
Credential	:	MD
Telephone Number	:	310-734-8526

Provider Enumeration Date	:	10/03/2019
Last Update Date	:	12/16/2025

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