Healthcare Provider Details

I. General information

NPI: 1992978712
Provider Name (Legal Business Name): JESSICA RAE HUNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2008
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E 3900 S STE 340
SALT LAKE CITY UT
84124-1228
US

IV. Provider business mailing address

1140 E 3900 S STE 300
SALT LAKE CITY UT
84124-1228
US

V. Phone/Fax

Practice location:
  • Phone: 801-743-4730
  • Fax: 801-743-4736
Mailing address:
  • Phone: 385-347-5450
  • Fax: 385-474-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6019946-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number6019946-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: