Provider Demographics
NPI:1225610231
Name:JAN, SAFIA (PA-C)
Entity Type:Individual
Prefix:
First Name:SAFIA
Middle Name:
Last Name:JAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 W 2200 S STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-7219
Mailing Address - Country:US
Mailing Address - Phone:801-412-6920
Mailing Address - Fax:877-497-4661
Practice Address - Street 1:4535 S 5600 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-4639
Practice Address - Country:US
Practice Address - Phone:801-676-4405
Practice Address - Fax:877-497-4661
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT13565323-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant