Healthcare Provider Details

I. General information

NPI: 1750922415
Provider Name (Legal Business Name): WOUNDTECH OF UTAH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 D ST
SALT LAKE CITY UT
84103-2831
US

IV. Provider business mailing address

PO BOX 202389
DALLAS TX
75320-2389
US

V. Phone/Fax

Practice location:
  • Phone: 954-923-7440
  • Fax: 954-923-1299
Mailing address:
  • Phone: 954-923-7440
  • Fax: 954-923-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MINGHSUN LIU
Title or Position: AUTHORIZED OFFICAIL
Credential: MD
Phone: 310-734-8526