Provider Demographics
NPI:1093725277
Name:HARRIS, GRACE KIM (DO)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:KIM
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1225 E FORT UNION BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1889
Mailing Address - Country:US
Mailing Address - Phone:801-233-4400
Mailing Address - Fax:801-233-4410
Practice Address - Street 1:1225 E FORT UNION BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1889
Practice Address - Country:US
Practice Address - Phone:801-233-4400
Practice Address - Fax:801-233-4410
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT53924561204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I07351Medicare UPIN