Healthcare Provider Details

I. General information

NPI: 1639019052
Provider Name (Legal Business Name): BRENDAN WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W 220 S
OREM UT
84058-5474
US

IV. Provider business mailing address

320 W 220 S
OREM UT
84058-5474
US

V. Phone/Fax

Practice location:
  • Phone: 909-472-7660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number00109620
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: