Provider Demographics
NPI:1992874358
Name:MOTOKI, DAVID S (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:MOTOKI
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 1:3980 S 700 E
Mailing Address - Street 2:SUITE 23
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2188
Mailing Address - Country:US
Mailing Address - Phone:801-261-5525
Mailing Address - Fax:801-261-8088
Practice Address - Street 1:3980 S 700 E
Practice Address - Street 2:SUITE 23
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2188
Practice Address - Country:US
Practice Address - Phone:801-261-5525
Practice Address - Fax:801-261-8088
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1675261205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E27794Medicare UPIN