Healthcare Provider Details

I. General information

NPI: 1457044414
Provider Name (Legal Business Name): NIKI XIRAN WAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 S 1200 E STE 103
SALT LAKE CITY UT
84105-3523
US

IV. Provider business mailing address

2021 E SUNNYSIDE AVE UNIT 6210
SALT LAKE CITY UT
84108-1496
US

V. Phone/Fax

Practice location:
  • Phone: 801-466-1212
  • Fax:
Mailing address:
  • Phone: 615-617-7018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14292332-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: