Healthcare Provider Details

I. General information

NPI: 1871502567
Provider Name (Legal Business Name): HENRY KLEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 W 9800 S STE 101
SOUTH JORDAN UT
84095-3221
US

IV. Provider business mailing address

3556 W 9800 S STE 101
SOUTH JORDAN UT
84095-3211
US

V. Phone/Fax

Practice location:
  • Phone: 801-567-9780
  • Fax: 801-567-9826
Mailing address:
  • Phone: 801-567-9780
  • Fax: 801-567-9826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number2747431205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: