Provider Demographics
NPI:1205559184
Name:HARUN, JALAL
Entity type:Individual
Prefix:
First Name:JALAL
Middle Name:
Last Name:HARUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5347 S 2150 W
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-1360
Mailing Address - Country:US
Mailing Address - Phone:385-630-5678
Mailing Address - Fax:
Practice Address - Street 1:5347 S 2150 W
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-1360
Practice Address - Country:US
Practice Address - Phone:385-630-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZJ62501265343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZJ62501265OtherLICENSE