Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 370379 | UT |
NPI | 1194837625 |
---|---|
Provider Name | Dr. Kyle S Christensen |
First Address | South Jordan, UT 84095-4653 |
Second Address | South Jordan, UT 84095-4653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U77294 | (02) | UT |