Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 12474837-1205 | UT |
N | 2084N0402X | Child Neurologist | A167664 | CA |
NPI | 1164800496 |
---|---|
Provider Name | Dr. Kavya Indira Rao |
First Address | Salt Lake City, UT 84106-1712 |
Second Address | Ogden, UT 84405-6905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2015 |
Last Update Date | 06/12/2021 |