Provider Demographics
NPI:1760415483
Name:VEIN INSTITUTE OF UTAH INC
Entity Type:Organization
Organization Name:VEIN INSTITUTE OF UTAH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HADJBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-748-0580
Mailing Address - Street 1:909 E 9400 S
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5514
Mailing Address - Country:US
Mailing Address - Phone:801-748-0580
Mailing Address - Fax:801-748-2274
Practice Address - Street 1:909 E 9400 S
Practice Address - Street 2:SUITE C
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5514
Practice Address - Country:US
Practice Address - Phone:801-748-0580
Practice Address - Fax:801-748-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52665561205207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529967032004Medicaid
UT000057788Medicare PIN
UTH99193Medicare UPIN