Provider Demographics
NPI:1700952231
Name:KJAR, JOSEPH GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GREGORY
Last Name:KJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 MEDICAL DR
Mailing Address - Street 2:STE #B-200
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4946
Mailing Address - Country:US
Mailing Address - Phone:801-295-9105
Mailing Address - Fax:801-295-9264
Practice Address - Street 1:415 MEDICAL DR
Practice Address - Street 2:STE #B-200
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4946
Practice Address - Country:US
Practice Address - Phone:801-295-9105
Practice Address - Fax:801-295-9264
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT170345-8905208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C63628Medicare UPIN
UTP00165761Medicare PIN
005770601Medicare ID - Type Unspecified