Healthcare Provider Details

I. General information

NPI: 1952210338
Provider Name (Legal Business Name): MALAZ KHAMIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S MAIN ST
TOOELE UT
84074-2163
US

IV. Provider business mailing address

6576 W OAK BRIDGE DR
WEST JORDAN UT
84081-1835
US

V. Phone/Fax

Practice location:
  • Phone: 435-255-6150
  • Fax:
Mailing address:
  • Phone: 908-500-8227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: