Healthcare Provider Details

I. General information

NPI: 1124163902
Provider Name (Legal Business Name): SOUTHERN UTAH ALLERGY AND ASTHMA CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E FOREMASTER DR STE 260
SAINT GEORGE UT
84790-4502
US

IV. Provider business mailing address

1490 E FOREMASTER DR STE 260
SAINT GEORGE UT
84790-4502
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-1128
  • Fax: 435-673-4045
Mailing address:
  • Phone: 435-688-1128
  • Fax: 435-673-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number5416150-1205
License Number StateUT

VIII. Authorized Official

Name: KENNETH R PINNA
Title or Position: PRESIDENT
Credential: MD
Phone: 435-688-1128