Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | A143092 | CA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 10478109-1205 | UT |
NPI | 1467751008 |
---|---|
Provider Name | Dr. Amir Allak |
First Address | West Jordan, UT 84088-4775 |
Second Address | West Jordan, UT 84088-4775 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2011 |
Last Update Date | 29/08/2017 |