Provider Demographics
NPI:1942257795
Name:LANGI, KINGI M (PAC, MT)
Entity Type:Individual
Prefix:
First Name:KINGI
Middle Name:M
Last Name:LANGI
Suffix:
Gender:M
Credentials:PAC, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E 900 S
Mailing Address - Street 2:STE 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:STE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1061331206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870460998008Medicaid
UT005762601Medicare ID - Type Unspecified
UTS74639Medicare UPIN
UT000012299Medicare ID - Type Unspecified