=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639310311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDNEY AND HYPERTENSION INSTITUTE OF UTAH, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2009
-----------------------------------------------------
Last Update Date | 07/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4780 OLD POST RD
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-4454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-476-3400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10273
-----------------------------------------------------
City | UNIONDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11555-0273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NEPHROLOGIST
-----------------------------------------------------
Name | HAMID MIAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 801-476-3400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 6667067
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------