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General NPI Number Information
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NPI Number | 1235339193
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Entity Type | Organization
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Legal Business Name | U-U PEDIATRIC DERMATOLOGY
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 100 N MEDICAL DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84113-1103
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Country | US
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Telephone | 801-587-6340
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Fax | 801-587-6346
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Provider Business Mailing Address
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Address Line | PO BOX 841052
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City | LOS ANGELES
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State | CA
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Zip | 90084-1450
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Country | US
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Telephone | 801-587-6340
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Fax | 801-587-6346
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | DR. KRISTINA CALLIS DUFFIN
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Credential | MD
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Telephone | 801-587-6336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 2752851205
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License Number State | UT
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