Healthcare Provider Details

I. General information

NPI: 1235624685
Provider Name (Legal Business Name): VERA KAZAKOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 CIRCLE OF HOPE DR
SALT LAKE CITY UT
84112-5500
US

IV. Provider business mailing address

1950 CIRCLE OF HOPE DR
SALT LAKE CITY UT
84112-5500
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-9439
  • Fax:
Mailing address:
  • Phone: 801-587-9439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number14210446-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: