Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 11062773-1205 | UT |
NPI | 1023589611 |
---|---|
Provider Name | Bahman Sotoodian |
First Address | Salt Lake City, UT 84101-1295 |
Second Address | Salt Lake City, UT 84101-1462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2018 |
Last Update Date | 17/12/2021 |