Individual
DR. KYLE SHIGERU MATSUMURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6750 S HIGHLAND DRIVE, STE 100, COTTONWOOD HEIGHTS, UT 84121
(801) 685-7246
(801) 747-5487
Mailing address
6750 S HIGHLAND DRIVE, STE 100, COTTONWOOD HEIGHTS, UT 84121
(801) 685-7246
(801) 747-5487
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
951306801205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
951306801205
UTAH MEDICAL LICENSE #
UT
05
—
D5367
—
UT
01
—
G79891
CAL MEDICAL LICENSE #
UT
Enumeration date
07/04/2006
Last updated
03/07/2023
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