Healthcare Provider Details

I. General information

NPI: 1316373731
Provider Name (Legal Business Name): MOHAMED HUSSEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S 200 E STE 250
SALT LAKE CITY UT
84111-5005
US

IV. Provider business mailing address

4519 S DAMSEL DR #E
MURRAY UT
84107-4286
US

V. Phone/Fax

Practice location:
  • Phone: 801-977-9119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: