Provider Demographics
NPI:1508073545
Name:KIDNEY & HYPERTENSION INSTITUTE OF UTAH PLLC
Entity Type:Organization
Organization Name:KIDNEY & HYPERTENSION INSTITUTE OF UTAH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:DMYTRIW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-809-2855
Mailing Address - Street 1:2132 N 1700 W
Mailing Address - Street 2:STE 110
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-7059
Mailing Address - Country:US
Mailing Address - Phone:801-779-3500
Mailing Address - Fax:801-779-3508
Practice Address - Street 1:2132 N 1700 W
Practice Address - Street 2:STE 110
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-7057
Practice Address - Country:US
Practice Address - Phone:801-779-3500
Practice Address - Fax:866-277-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT64199708905174400000X
207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG39399Medicare UPIN
000061365Medicare PIN
G39399Medicare UPIN