Individual
SARMISHTA DIRAVIAM KANNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(978) 376-5797
Mailing address
295 S CHIPETA WAY RM 2S010, SALT LAKE CITY, UT 84108-1287
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
14245981-1205
UT
Other
Enumeration date
06/10/2022
Last updated
10/29/2025
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