Healthcare Provider Details

I. General information

NPI: 1427781566
Provider Name (Legal Business Name): DIANNA KOA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 S 800 W
BRIGHAM CITY UT
84302-3042
US

IV. Provider business mailing address

971 S 800 W
BRIGHAM CITY UT
84302-3042
US

V. Phone/Fax

Practice location:
  • Phone: 435-239-8445
  • Fax:
Mailing address:
  • Phone: 435-239-8445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: