Provider Demographics
NPI:1518985696
Name:BUCHI, KENNETH N (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:N
Last Name:BUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 W 9000 S STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5711
Mailing Address - Country:US
Mailing Address - Phone:801-233-8233
Mailing Address - Fax:801-565-3663
Practice Address - Street 1:3584 W 9000 S STE 300
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5711
Practice Address - Country:US
Practice Address - Phone:801-233-8233
Practice Address - Fax:801-565-3663
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT791639761205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD07516Medicare UPIN
000060224Medicare PIN