Provider Demographics
NPI:1952103590
Name:VADIPOUR, ARY
Entity type:Individual
Prefix:
First Name:ARY
Middle Name:
Last Name:VADIPOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 E VILLA PARK LN
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5917
Mailing Address - Country:US
Mailing Address - Phone:801-557-8888
Mailing Address - Fax:
Practice Address - Street 1:1908 E VILLA PARK LN
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84121-5917
Practice Address - Country:US
Practice Address - Phone:801-557-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12277586-1702390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program