Healthcare Provider Details

I. General information

NPI: 1508092198
Provider Name (Legal Business Name): JEN-YU WEI D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY WEI D.O

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0100
US

IV. Provider business mailing address

PO BOX 413033
SALT LAKE CITY UT
84141-3033
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7818
  • Fax:
Mailing address:
  • Phone: 801-213-3900
  • Fax: 801-585-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9089513-1204
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number9089513-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: