Healthcare Provider Details

I. General information

NPI: 1760415483
Provider Name (Legal Business Name): VEIN INSTITUTE OF UTAH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E 9400 S SUITE C
SANDY UT
84094-5514
US

IV. Provider business mailing address

909 E 9400 S SUITE C
SANDY UT
84094-5514
US

V. Phone/Fax

Practice location:
  • Phone: 801-748-0580
  • Fax: 801-748-2274
Mailing address:
  • Phone: 801-748-0580
  • Fax: 801-748-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number52665561205
License Number StateUT

VIII. Authorized Official

Name: EHSAN HADJBIAN
Title or Position: OWNER
Credential: M.D.
Phone: 801-748-0580