Provider Demographics
NPI:1326832965
Name:JOSEPH, JOHN LUDANGA
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LUDANGA
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AUGUSTINE
Other - Middle Name:LEMI
Other - Last Name:WILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1385 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5582
Mailing Address - Country:US
Mailing Address - Phone:801-580-2490
Mailing Address - Fax:
Practice Address - Street 1:1385 S STATE ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-5582
Practice Address - Country:US
Practice Address - Phone:801-580-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator