Provider Demographics
NPI:1609930726
Name:LIHAI MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:LIHAI MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KINGI
Authorized Official - Middle Name:MOSAIA
Authorized Official - Last Name:LANGI
Authorized Official - Suffix:SR
Authorized Official - Credentials:PAC MT
Authorized Official - Phone:801-687-0511
Mailing Address - Street 1:313 E 900 S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-4315
Mailing Address - Country:US
Mailing Address - Phone:801-532-2265
Mailing Address - Fax:801-532-2351
Practice Address - Street 1:313 E 900 S
Practice Address - Street 2:SUITE 102
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-4315
Practice Address - Country:US
Practice Address - Phone:801-532-2265
Practice Address - Fax:801-532-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057626Medicare PIN