Provider Demographics
NPI:1891336194
Name:UTAH KIDNEY INSTITUTE, LLC
Entity Type:Organization
Organization Name:UTAH KIDNEY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:CHADHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-809-4425
Mailing Address - Street 1:4287 HARRISON BLVD # 156
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3101
Mailing Address - Country:US
Mailing Address - Phone:385-350-8500
Mailing Address - Fax:385-350-8555
Practice Address - Street 1:4345 HARRISON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3103
Practice Address - Country:US
Practice Address - Phone:385-350-8500
Practice Address - Fax:385-350-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty