Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 6555293-1205 | UT |
NPI | 1013908995 |
---|---|
Provider Name | Kevin L Jansen |
First Address | South Salt Lake, UT 84115-5096 |
Second Address | South Salt Lake, UT 84115-5096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4828000340001 | (05) | UT |
H99938 | (02) | MA |