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Individual

KELLEN TAGE HANSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
3401 N CENTER ST STE 100, LEHI, UT 84043
(801) 753-7770
(801) 753-7775
Mailing address
3401 N CENTER ST STE 100, LEHI, UT 84043-7498
(801) 753-7770
(801) 753-7775

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
02004307A
IN
207Q00000X
Family Medicine Physician
02004307A
IN
207Q00000X
Family Medicine Physician
10266619-1204
UT
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
10266619-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
IN

Other

Enumeration date
06/14/2012
Last updated
11/21/2019
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