Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 9771319-1205 | UT |
NPI | 1447559778 |
---|---|
Provider Name | Khanh Van Lai |
First Address | Salt Lake City, UT 84130-0180 |
Second Address | Salt Lake City, UT 84113-1125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2011 |
Last Update Date | 15/12/2021 |