1215125307 NPI number — OUR HOUSE OF CENTRAL SANDY

Table of content: DR. FABIO HUANG YE PHARMD (NPI 1740870237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215125307 NPI number — OUR HOUSE OF CENTRAL SANDY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUR HOUSE OF CENTRAL SANDY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215125307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9532 SOUTH 700 EAST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-572-1298
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 E 600 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAYSVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84037-1470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-918-7707
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOSWELL
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
801-918-7707

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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