Provider Demographics
NPI:1053466789
Name:KENNETH BUCHI MD A P C
Entity Type:Organization
Organization Name:KENNETH BUCHI MD A P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:BUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-254-8620
Mailing Address - Street 1:3584 WEST 9000 SOUTH
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5711
Mailing Address - Country:US
Mailing Address - Phone:801-233-8233
Mailing Address - Fax:801-254-8620
Practice Address - Street 1:3584 WEST 9000 SOUTH
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5711
Practice Address - Country:US
Practice Address - Phone:801-233-8233
Practice Address - Fax:801-254-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT163976-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT571587410040Medicaid
UT571587410040Medicaid