Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 5912000-1205 | UT |
NPI | 1154381689 |
---|---|
Provider Name | Kristian Kemp |
First Address | Salt Lake City, UT 84111-1206 |
Second Address | Ogden, UT 84405-6905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 21/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D6173 | (05) | UT |
I34687 | (02) | UT |