Individual
KHANH VIET TONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
177 W PRICE AVE, SALT LAKE CITY, UT 84115-4345
(385) 468-4435
Mailing address
177 W PRICE AVE, SALT LAKE CITY, UT 84115-4345
(385) 468-4435
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8847099-3502
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HT002258001
—
UT
Enumeration date
08/09/2011
Last updated
07/21/2022
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