Healthcare Provider Details

I. General information

NPI: 1578208542
Provider Name (Legal Business Name): MALINA PISEY ONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
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: 801-587-7000
  • Fax:
Mailing address:
  • Phone: 801-587-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14184282-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: