Provider Demographics
NPI:1023589611
Name:SOTOODIAN, BAHMAN (MD, FRCP(C), FAAD)
Entity type:Individual
Prefix:
First Name:BAHMAN
Middle Name:
Last Name:SOTOODIAN
Suffix:
Gender:M
Credentials:MD, FRCP(C), FAAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S 500 W APT 321
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1295
Mailing Address - Country:US
Mailing Address - Phone:518-801-7415
Mailing Address - Fax:
Practice Address - Street 1:440 W 200 S STE 250
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1462
Practice Address - Country:US
Practice Address - Phone:801-595-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11062773-1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology