Provider Demographics
NPI:1356335970
Name:THORNE, J KENT (MD)
Entity type:Individual
Prefix:
First Name:J
Middle Name:KENT
Last Name:THORNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 E 3900 S
Mailing Address - Street 2:#3500
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1202
Mailing Address - Country:US
Mailing Address - Phone:801-743-4750
Mailing Address - Fax:801-743-4765
Practice Address - Street 1:1160 E 3900 S
Practice Address - Street 2:#3500
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1202
Practice Address - Country:US
Practice Address - Phone:801-743-4750
Practice Address - Fax:801-743-4765
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT164516-8905208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT164516-8905OtherMEDICAL LICENSE
UT06286Medicaid
UTP00424169OtherRR MEDICARE
UTD07596Medicare UPIN
UTP00424169OtherRR MEDICARE
UT000060110Medicare PIN