MEDICARE: KENNETH R PINNA M.D.

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	541616501205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9385678	OTHER	UT	PRIVATE HEALTH CARE SYSTE
2	0200037	OTHER	UT	UNITED HEALTH CARE
3	81217	OTHER	UT	PUBLIC EMPLOYEES HEALTH P
4	107023322102	OTHER	UT	INTERMOUNTAIN HEALTH CARE
5	233306	OTHER	UT	ALTIUS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	200355426KRP	OTHER	UT	EDUCATORS MUTUAL
8	7358374	OTHER	UT	AETNA
9	54161501202001	OTHER	UT	BLUE CROSS/ BLUE SHIELD
10	5595330	OTHER	UT	FIRST HEALTH

General Provider Information

NPI Number	:	1568423879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH R PINNA M.D.

Provider Business Mailing Address
First Line	:	515 S 300 E STE 101
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84770-3931
Country	:	US
Telephone Number	:	435-688-1128
Fax Number	:	435-673-4045

Provider Business Practice Location Address
First Line	:	515 S 300 E, STE 101
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84770-3900
Country	:	US
Telephone Number	:	435-688-1128
Fax Number	:	435-673-4045

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	04/06/2011

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Directions to “ KENNETH R PINNA M.D.” Practice Location

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