Provider Demographics
NPI:1902136013
Name:KIDNEY AND INTERNAL MEDICINE
Entity Type:Organization
Organization Name:KIDNEY AND INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNEJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-542-7115
Mailing Address - Street 1:1561 W 7000 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-3556
Mailing Address - Country:US
Mailing Address - Phone:801-352-2700
Mailing Address - Fax:801-352-0400
Practice Address - Street 1:1561 W 7000 S
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-3556
Practice Address - Country:US
Practice Address - Phone:801-542-7115
Practice Address - Fax:801-352-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51624871205207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty