Provider Demographics
NPI:1093878860
Name:HANSON, KIMBERLY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N 1900E SCHOOL OF MEDICINE
Mailing Address - Street 2:UNIVERSITY OF UTAH
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108
Mailing Address - Country:US
Mailing Address - Phone:801-581-8812
Mailing Address - Fax:801-585-3377
Practice Address - Street 1:30 N 1900E SCHOOL OF MEDICINE
Practice Address - Street 2:UNIVERSITY OF UTAH
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108
Practice Address - Country:US
Practice Address - Phone:801-581-8812
Practice Address - Fax:801-585-3377
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6972454-1205207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
I47188Medicare ID - Type Unspecified
NC5902487Medicare ID - Type Unspecified
NC2048916Medicare ID - Type Unspecified