Provider Demographics
NPI:1912489790
Name:SARA TARJAN, LLC
Entity type:Organization
Organization Name:SARA TARJAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-369-4091
Mailing Address - Street 1:1718 S 900 E APT D
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3277
Mailing Address - Country:US
Mailing Address - Phone:773-369-4091
Mailing Address - Fax:
Practice Address - Street 1:300 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4218
Practice Address - Country:US
Practice Address - Phone:435-637-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10714502-1205207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty