Kkmmcb Medical, PLLC

Primary specialty

Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X

Legal business name

KKMMCB MEDICAL, PLLC

Practice address

9980 South 300 West Suite 200
Sandy, UT 84070

Phone

(385) 254-0279

NPI assigned

Jan 18, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lizette Morin

Title

MDMS Npi Compliance Officer

Phone

(210) 598-2800

Specialties & licenses 4

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516233600000",
    "number": "1033627591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1338 S FOOTHILL DR #331",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841082321",
            "telephone_number": "385-254-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9980 SOUTH 300 WEST SUITE 200",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "84070",
            "telephone_number": "385-254-0279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KKMMCB MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2018-01-18",
        "status": "A",
        "authorized_official_last_name": "MORIN",
        "authorized_official_first_name": "LIZETTE",
        "authorized_official_title_or_position": "MDMS NPI COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "210-598-2800"
    },
    "taxonomies": [
        {
            "code": "204R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Electrodiagnostic Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "246ZE0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kind Minds Counseling of Utah LLC
• Phoebe Consue King, M.D.
• Lawrence Francis Kirigin, RPH
• Timothy Alan Kirkland, DVM
• Rhonda Marie Kistler, CSW, LCSW
• Ashley Klungervik, L.M.T.
• Knew Visions Inc.
• Stephanie Elizabeth Knight
• Tyler Chandler Knight, MS, ATC, PES, CES
• Jessica Lyn Knowles, RBT

• Clinical Neurophysiology Physician in Sandy, UT
• Providers in Sandy, UT by specialty
• Clinical Neurophysiology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.