Healthcare Provider Details

I. General information

NPI: 1356261853
Provider Name (Legal Business Name): MOHMMAD BAQAR AL-SAEDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 E STRINGHAM AVE
SALT LAKE CITY UT
84106-2490
US

IV. Provider business mailing address

1280 E STRINGHAM AVE
SALT LAKE CITY UT
84106-2490
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number12308419-1702
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: