Provider Demographics
NPI:1558332437
Name:HEJAZI, JAMAL S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:S
Last Name:HEJAZI
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 1:1141 E 3900 S STE A170
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1250
Mailing Address - Country:US
Mailing Address - Phone:801-284-4990
Mailing Address - Fax:
Practice Address - Street 1:1141 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1250
Practice Address - Country:US
Practice Address - Phone:801-284-4990
Practice Address - Fax:801-284-4991
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9926378312052084P0800X, 2084P0804X
NV76082084P0800X, 2084P0804X
CAA497142084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942938348HE2OtherEDUCATORS MUTUAL
UT107007645101OtherINTRMTN HEALTH CARE
UT263060OtherDESERET MUTUAL
UT000060288Medicare PIN
UT002200153Medicare PIN
UT002200131Medicare PIN
UT107007645101OtherINTRMTN HEALTH CARE
UT002200175Medicare PIN