Healthcare Provider Details

I. General information

NPI: 1306289780
Provider Name (Legal Business Name): KANDA HAZELWOOD DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9414 S 1335 E
SANDY UT
84092-2947
US

IV. Provider business mailing address

9414 S 1335 E
SANDY UT
84092-2947
US

V. Phone/Fax

Practice location:
  • Phone: 801-523-1176
  • Fax: 801-553-3568
Mailing address:
  • Phone: 801-523-1176
  • Fax: 801-553-3568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number3319482801
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: