Healthcare Provider Details

I. General information

NPI: 1851357230
Provider Name (Legal Business Name): PAUL S LEI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 801-567-9750
  • Fax: 801-567-9750
Mailing address:
  • Phone: 801-352-9500
  • Fax: 801-352-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number363788-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: