Healthcare Provider Details

I. General information

NPI: 1952609687
Provider Name (Legal Business Name): QC KIDZ PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 SOUTH BLVD
CHARLOTTE NC
28217-4458
US

IV. Provider business mailing address

6801 SOUTH BLVD
CHARLOTTE NC
28217-4458
US

V. Phone/Fax

Practice location:
  • Phone: 704-340-3923
  • Fax:
Mailing address:
  • Phone: 704-340-3923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number2005-01936
License Number StateNC

VIII. Authorized Official

Name: DR. JANCY UTOH
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 704-340-3923