Healthcare Provider Details

I. General information

NPI: 1093923591
Provider Name (Legal Business Name): UTAH LUNG CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3584 W 9000 S
WEST JORDAN UT
84088
US

IV. Provider business mailing address

PO BOX 150173
OGDEN UT
84415
US

V. Phone/Fax

Practice location:
  • Phone: 801-562-5864
  • Fax: 801-568-0202
Mailing address:
  • Phone: 801-479-0601
  • Fax: 801-479-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number180183-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number180183-1205
License Number StateUT

VIII. Authorized Official

Name: IMAD S FARRUKH
Title or Position: PRESIDENT
Credential: MD
Phone: 801-562-5864