Healthcare Provider Details

I. General information

NPI: 1932793114
Provider Name (Legal Business Name): SEAN MATTHEW KING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E 100 S STE 301
SALT LAKE CITY UT
84111-1727
US

IV. Provider business mailing address

3148 S 1100 W
WEST VALLEY CITY UT
84119-3304
US

V. Phone/Fax

Practice location:
  • Phone: 801-428-4257
  • Fax:
Mailing address:
  • Phone: 760-972-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: