Provider Demographics
NPI:1104987916
Name:KAMALU, LAYNE K (MD)
Entity type:Individual
Prefix:DR
First Name:LAYNE
Middle Name:K
Last Name:KAMALU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:120 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2527
Mailing Address - Country:US
Mailing Address - Phone:801-544-4227
Mailing Address - Fax:801-544-3724
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-2527
Practice Address - Country:US
Practice Address - Phone:801-544-4227
Practice Address - Fax:801-544-3724
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT321149-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG34786Medicare UPIN
UT005568202Medicare PIN