Khodakov, Yuri

Khodakov, Yuri is an individual health care provider with primary practice located at 4403 Harrison Blvd Suite 3490, Ogden UT 84403-3271. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Cardiology, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Interventional Cardiology is his primary health care specialty. Khodakov, Yuri can be contacted via phone (801) 387-2650.

Contact Information

Primary practice address
4403 Harrison Blvd Suite 3490 Ogden UT 84403-3271
Phone: (801) 387-2650
Fax: (801) 387-2655
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 6656163-1205 Utah
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 6656163-1205 Utah

Profile Details

NPI number 1700099983
LBN Legal business name Khodakov, Yuri
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 7th, 2007
Last updated Jul 3rd, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700099983 NPPES
Utah MEDICAID 1114055241

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