Individual
DR. YURI KHODAKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4403 HARRISON BLVD, SUITE 3490, OGDEN, UT 84403-3271
(801) 387-2650
(801) 387-2655
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 387-2650
(801) 387-2655
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
6656163-1205
UT
207RI0011X
Interventional Cardiology Physician
Primary
6656163-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114055241
—
UT
Enumeration date
05/07/2007
Last updated
07/03/2008
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