Healthcare Provider Details

I. General information

NPI: 1366560484
Provider Name (Legal Business Name): JAHAN IMANI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 ADAMS AVE PKWY SUITE A
WASHINGTON TERRACE UT
84405-4766
US

IV. Provider business mailing address

P.O. BOX 9519
OGDEN UT
84409
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-5950
  • Fax: 801-475-7322
Mailing address:
  • Phone: 801-475-7707
  • Fax: 801-475-7322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number57891911205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number58040891205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number51777271205
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2606151205
License Number StateUT

VIII. Authorized Official

Name: DR. JAHAN IMANI
Title or Position: LEAD PHYSICIAN
Credential: MD
Phone: 801-475-7707