Provider Demographics
NPI:1457300980
Name:KLEIN, REGINA C
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:C
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E 3900 S
Mailing Address - Street 2:SUITE C-240
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1214
Mailing Address - Country:US
Mailing Address - Phone:801-266-0878
Mailing Address - Fax:801-266-2074
Practice Address - Street 1:1492 W ANTELOPE DR
Practice Address - Street 2:SUITE 125
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1139
Practice Address - Country:US
Practice Address - Phone:801-525-3022
Practice Address - Fax:801-775-9508
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT274783-1205207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107007421101OtherSELECT HEALTH
UT110112716OtherRAILROAD MEDICARE
UT107007421101OtherSELECT HEALTH
UT005717208Medicare PIN