Provider Demographics
NPI:1912394735
Name:BJELLA, KIRK (MD)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:BJELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N PAIUTE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-6181
Mailing Address - Country:US
Mailing Address - Phone:435-867-1520
Mailing Address - Fax:435-867-2658
Practice Address - Street 1:376 N PAIUTE DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-6181
Practice Address - Country:US
Practice Address - Phone:435-586-1112
Practice Address - Fax:435-867-2658
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157281208000000X
UT10117282-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics