Healthcare Provider Details

I. General information

NPI: 1447660337
Provider Name (Legal Business Name): SEAN T KENDALL PA-C, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 S 900 E
SALT LAKE CITY UT
84102-2310
US

IV. Provider business mailing address

428 E DOWNINGTON AVE APT 1
SALT LAKE CITY UT
84115-2256
US

V. Phone/Fax

Practice location:
  • Phone: 385-282-2400
  • Fax:
Mailing address:
  • Phone: 435-790-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number8001227-4810
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number8001227-1206
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8001227-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: