MEDICARE: JOSEPH GREGORY KJAR 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	208200000X	Plastic Surgery Physician	170345-8905	UT

General Provider Information

NPI Number	:	1700952231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH GREGORY KJAR M.D.

Provider Business Mailing Address
First Line	:	415 MEDICAL DR
Second Line	:	STE #B-200
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-4946
Country	:	US
Telephone Number	:	801-295-9105
Fax Number	:	801-295-9264

Provider Business Practice Location Address
First Line	:	415 MEDICAL DR
Second Line	:	STE #B-200
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-4946
Country	:	US
Telephone Number	:	801-295-9105
Fax Number	:	801-295-9264

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/24/2015

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