NPIMap

Organization Active NPI

U-U Pediatric Dermatology

  • Pediatric Dermatology Physician
  • Salt Lake City, UT
National Provider Identifier
1235339193
Registry record updated Mar 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Dermatology PhysicianTaxonomy code 207NP0225X
License
2752851205 Issued in UT
Legal business name
U-U PEDIATRIC DERMATOLOGY
Practice address
100 N Medical Dr
Salt Lake City, UT 84113-1103
Phone
(801) 587-6340
Fax
(801) 587-6346
NPI assigned
Jul 19, 2007
Last updated
Mar 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2025

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

Authorized official

Name
Dr. Kristina Callis Duffin, MDNPI 1659397040
Title
Chief Clinical Officer
Phone
(801) 587-6336

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dermatology Physician 207NP0225X 2752851205 UT Primary

Addresses

Primary practice location

100 N Medical Dr
Salt Lake City, UT 84113-1103

Mailing address

PO Box 841052
Los Angeles, CA 90084-1450
Phone (801) 587-6340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041020000616 UT Part B Supplier - Clinic/Group Practice 8729049002 Receives reassigned benefits from 45 practitioners
Practice locations: Salt Lake City, UT

National Provider Directory

National Provider Directory

Locations

417 S Wakara Way
Salt Lake City, UT 84108
Phone (801) 581-3506

Practitioners & affiliated clinicians

Practitioners 138

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 138

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741046400000",
    "number": "1235339193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841052",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900841450",
            "telephone_number": "801-587-6340",
            "fax_number": "801-587-6346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MEDICAL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841131103",
            "telephone_number": "801-587-6340",
            "fax_number": "801-587-6346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "U-U PEDIATRIC DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A",
        "authorized_official_last_name": "DUFFIN",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_middle_name": "CALLIS",
        "authorized_official_title_or_position": "CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "801-587-6336",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "UT",
            "license": "2752851205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.