| NPI |
1730796152 |
The State code in the location of the provider
being identified. |
| Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
| Provider Organization Name Legal Business Name |
JOC SJT |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Provider First Line Business Practice Location Address |
2651 W SOUTH JORDAN PKWY STE 201 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Provider Business Practice Location Address City Name |
SOUTH JORDAN |
The date that a record was last updated or changed. |
| Provider Business Practice Location Address State Name |
UT |
The code designating the provider’s gender if the provider is a person. |
| Provider Business Practice Location Address Postal Code |
840958966 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Provider Business Practice Location Address Telephone Number |
8012542700 |
|
| Provider Enumeration Date |
9/29/2020 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| Last Update Date |
9/29/2020 |
|
| Authorized Official Last Name |
JENSEN |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Authorized Official First Name |
ALAN |
The first name of the authorized official. |
| Authorized Official Middle Name |
C |
The middle name of the authorized official. |
| Authorized Official Title or Position |
OWNER |
The title or position of the authorized official. |
| Authorized Official Telephone Number |
8012729900 |
The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code 1 |
261QD0000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Is Organization Subpart |
N |
|
| Authorized Official Credential Text |
MS, DDS |
|
| NPI Certification Date |
9/29/2020 |
|