Individual
JARED TAKESHI AIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1160 E 3900 S STE 4050, SALT LAKE CITY, UT 84124-1264
(801) 262-8486
(801) 284-8699
Mailing address
280 S MAIN ST, BOUNTIFUL, UT 84010-6236
(801) 505-0821
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
123456-1205
UT
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
123456-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12573316-1204
LICENSE
UT
Enumeration date
06/09/2014
Last updated
08/24/2023
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