MEDICARE: JAHAN IMANI MD PC

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	174400000X	Specialist	57891911205	UT
2	174400000X	Specialist	58040891205	UT
3	174400000X	Specialist	51777271205	UT
4	174400000X	Specialist	2606151205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000057660	OTHER	UT	GOUP MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366560484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAHAN IMANI MD PC

Provider Business Mailing Address
First Line	:	P.O. BOX 9519
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84409
Country	:	US
Telephone Number	:	801-475-7707
Fax Number	:	801-475-7322

Provider Business Practice Location Address
First Line	:	5315 ADAMS AVE PKWY
Second Line	:	SUITE A
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-4766
Country	:	US
Telephone Number	:	801-475-5950
Fax Number	:	801-475-7322

Authorized Official
Title or Position	:	LEAD PHYSICIAN
Name	:	DR. JAHAN IMANI
Credential	:	MD
Telephone Number	:	801-475-7707

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	05/13/2019

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Directions to “JAHAN IMANI MD PC ” Practice Location

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