MEDICARE: KIAH LYNN CARDENAS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	13676616-1206	UT
2	363AM0700X	Medical Physician Assistant	54827	CA
3	363AS0400X	Surgical Physician Assistant	54827	CA
4	363A00000X	Physician Assistant	54827	CA

General Provider Information

NPI Number	:	1144747403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIAH LYNN CARDENAS PA

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 HOWLE AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2449
Country	:	US
Telephone Number	:	833-225-3558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	05/15/2026

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