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General NPI Number Information
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NPI Number | 1952609687
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Entity Type | Organization
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Legal Business Name | QC KIDZ PEDIATRICS PLLC
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 6801 SOUTH BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28217-4458
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Country | US
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Telephone | 704-340-3923
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Fax |
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Provider Business Mailing Address
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Address Line | 6801 SOUTH BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28217-4458
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Country | US
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Telephone | 704-340-3923
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Fax |
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. JANCY UTOH
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Credential | MD
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Telephone | 704-340-3923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2005-01936
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License Number State | NC
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