Healthcare Provider Details

I. General information

NPI: 1750025532
Provider Name (Legal Business Name): JACOB S. KLUVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 S CHIPETA WAY RM 2000
SALT LAKE CITY UT
84108-1287
US

IV. Provider business mailing address

295 S CHIPETA WAY RM 2000
SALT LAKE CITY UT
84108-1287
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax: 919-966-8419
Mailing address:
  • Phone: 801-581-2121
  • Fax: 919-966-8419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number14206539-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: