=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770353740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIWI KIDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2024
-----------------------------------------------------
Last Update Date | 01/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11629 S 700 E STE 125
-----------------------------------------------------
City | DRAPER
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84020-8382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-831-8675
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11629 S 700 E STE 125
-----------------------------------------------------
City | DRAPER
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84020-8382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-831-8675
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR / MANAGER
-----------------------------------------------------
Name | MS. VAISHALI AGARWAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 385-831-8675
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1800X
-----------------------------------------------------
Taxonomy Name | Corporate Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------