Healthcare Provider Details

I. General information

NPI: 1760484596
Provider Name (Legal Business Name): HARRY O SENEKJIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD SUITE 2635
OGDEN UT
84403-3244
US

IV. Provider business mailing address

4403 HARRISON BLVD SUITE 2635
OGDEN UT
84403-3244
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-6820
  • Fax: 801-387-6825
Mailing address:
  • Phone: 801-387-6820
  • Fax: 801-387-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number169315 1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number169315
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: