Provider Demographics
NPI:1033421722
Name:KINGSTON, JOSEPH L (DO)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:KINGSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6933 S 1300 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-2554
Mailing Address - Country:US
Mailing Address - Phone:801-327-8707
Mailing Address - Fax:801-748-0423
Practice Address - Street 1:6933 S 1300 W
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-2554
Practice Address - Country:US
Practice Address - Phone:801-327-8707
Practice Address - Fax:801-748-0423
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1818208000000X
UT84834191204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ81039OtherTRAINING PERMIT
UT8483419-1204OtherLICENSE
UT8483419-1204OtherLICENSE