Provider Demographics
NPI:1780947671
Name:KAZINA, COLIN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:JOHN
Last Name:KAZINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MARIO CAPECCHI DR
Mailing Address - Street 2:1475
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84113-1103
Mailing Address - Country:US
Mailing Address - Phone:801-662-5349
Mailing Address - Fax:801-662-5345
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:1475
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-5349
Practice Address - Fax:801-662-5345
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8347726-1205390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program