KKMMCB MEDICAL, PLLC (NPI# 1033627591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033627591 |
| Entity Type | Organization |
| Organization Name | KKMMCB MEDICAL, PLLC |
| Practice Address |
9980 South 300 West Suite 200 Sandy UT 84070 |
| Mailing Address |
1338 S Foothill Dr #331 Salt Lake City UT 84108-2321 |
| Practice Telephone | 3852540279 |
| Mailing Telephone | 3852540279 |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-01-18 |
| Authorized Official Name | LIZETTE MORIN (MDMS NPI COMPLIANCE OFFICER) |
| Authorized Official Telephone | 2105982800 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204R00000X | Electrodiagnostic Medicine | Allopathic & Osteopathic Physicians | ||
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
| N | 246ZE0600X |
Specialist/Technologist, Other Specialization: Electroneurodiagnostic |
Technologists, Technicians & Other Technical Service Providers | ||
| Y | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
Allopathic & Osteopathic Physicians |
| Street Address |
9980 SOUTH 300 WEST SUITE 200 |
| City | SANDY |
| State | UT |
| Zip Code | 84070 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639777568 | Megan Komatsu Inc. | Social Worker | 10815 700 East, Sandy, UT 84070 | 2020-10-13 |
| 1841803137 | Anywhere Care | Nurse Practitioner | 9980 S. 300 W. Suite 200, Sandy, UT 84070 | 2020-08-26 |
| 1245840552 | Kirandeep Kaur | Psychologist | 9678 700 E # 102, Sandy, UT 84070 | 2020-08-03 |
| 1740890961 | Elizabeth Lowe Madsen | Counselor | 9678 700 East Suite 102, Sandy, UT 84070 | 2020-08-03 |
| 1417597188 | Hayley Burr | Counselor | 8706 700 E, Suite 205, Sandy, UT 84070 | 2020-01-10 |
| 1821656422 | Karen Ritchie | Counselor | 9192 South 300 West, Sandy, UT 84070 | 2019-05-30 |
| 1679068159 | Derek Livingston | Counselor | 11075 State St #35, Sandy, UT 84070 | 2018-06-27 |
| 1891283735 | Alta Rx LLC. | Pharmacy | 9883 South 500 West, Sandy, UT 84070 | 2018-04-26 |
| 1790273704 | The Addiction Medicine Physicians Group, LLC | Registered Nurse | 9160 S 300 E. Ste 25, Sandy, UT 84070 | 2018-04-25 |
| 1841794765 | Caryn Beazel | Physical Therapist | 9350 150 E, Sandy, UT 84070 | 2018-03-23 |
| Find all providers in zip 84070 | ||||
| Taxonomy Code | 2084N0600X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Clinical Neurophysiology |
| Clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using combined clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS). |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285867275 | Hansann & Associates | Psychiatry & Neurology | 1470 S 500 E, Kaysville, UT 84037-3033 | 2009-08-25 |
| 1871679787 | Kevin Scott Mochizuki | Psychiatry & Neurology | 428 S Douglas St Apt 1, Salt Lake City, UT 84102 | 2006-10-31 |
| 1619965944 | Navin K Varma | Psychiatry & Neurology | 1452 E Ridgeline Dr #151, Ogden, UT 84405-4975 | 2005-10-11 |
| 1093710188 | Stephen Peters | Psychiatry & Neurology | 1157 N 300 W, Provo, UT 84604-6124 | 2005-06-16 |
| 1285279091 | Blue Creek Medical | Psychiatry & Neurology | 9825 N 10800 W, Tremonton, UT 84337-9222 | 2019-11-15 |
| 1508098906 | Timber Ridge Holdings LLC | Psychiatry & Neurology | 448 E 5350 S Ste B, Washington Terrace, UT 84405-5415 | 2009-08-18 |
| 1891802591 | Tawnya M. Constantino | Psychiatry & Neurology | 5171 Cottonwood St, Suite 810, Murray, UT 84107-5704 | 2006-08-25 |
Please comment or provide details below to improve the information on KKMMCB MEDICAL, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.