Healthcare Provider Details

I. General information

NPI: 1508073545
Provider Name (Legal Business Name): KIDNEY & HYPERTENSION INSTITUTE OF UTAH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 N 1700 W STE 110
LAYTON UT
84041-7057
US

IV. Provider business mailing address

2132 N 1700 W STE 110
LAYTON UT
84041-7059
US

V. Phone/Fax

Practice location:
  • Phone: 801-779-3500
  • Fax: 866-277-0853
Mailing address:
  • Phone: 801-779-3500
  • Fax: 801-779-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number64199708905
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTI DMYTRIW
Title or Position: VP OF OPERATIONS
Credential:
Phone: 303-809-2855