Healthcare Provider Details

I. General information

NPI: 1235339193
Provider Name (Legal Business Name): U-U PEDIATRIC DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MEDICAL DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

PO BOX 841052
LOS ANGELES CA
90084-1450
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-6340
  • Fax: 801-587-6346
Mailing address:
  • Phone: 801-587-6340
  • Fax: 801-587-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number2752851205
License Number StateUT

VIII. Authorized Official

Name: DR. KRISTINA CALLIS DUFFIN
Title or Position: CHIEF CLINICAL OFFICER
Credential: MD
Phone: 801-587-6336