DR. DOUGLAS GAVIN KONDO M.D. NPI 1083703284

NPI Information

NPI: 1083703284
Provider Name: DR. DOUGLAS GAVIN KONDO, M.D.
Classification: Psychiatry & Neurology - 2084P0804X
Entity Type: Individual

Specialization: Child & Adolescent Psychiatry

PECOS Registration: Yes

Address:
501 S CHIPETA WAY
SALT LAKE CITY, UT
ZIP 84108
Phone: (801) 585-1575
Get Directions

DR. Douglas Gavin Kondo, M.D. is a child and adolescent psychiatry psychiatry neurology in Salt Lake City, UT. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. DR. Douglas Gavin Kondo, M.D. NPI is 1083703284. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

501 S CHIPETA WAY
SALT LAKE CITY, UT
ZIP 84108-222
Phone: (801) 585-1575

The NPI 1083703284 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/12/2006 and was last updated on 11/17/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0800X	Psychiatry & Neurology	Psychiatry	6313601-1205	UTAH	No
2	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry	6313601-1205	UTAH	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	11725447	OTHER	UTAH	CAQH NUMBER
2	6313601-1205	OTHER	UTAH	UTAH MEDICAL LICENSE
3	BK-6405701	OTHER	UTAH	DEA NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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